Your salivary glands make saliva - sometimes called spit - and empty it into your mouth through openings called ducts. Saliva makes your food moist, which helps you chew and swallow. It helps you digest your food. It also cleans your mouth and contains antibodies that can kill germs.

Salivary gland cancer is a type of head and neck cancer. It is rare. It may not cause any symptoms, or you could notice:

• A lump in your ear, cheek, jaw, lip, or inside the mouth
• Fluid draining from your ear
• Trouble swallowing or opening the mouth widely
• Numbness, weakness, or pain in your face

Doctors diagnose salivary gland cancer using a physical exam, imaging tests, and a biopsy. Treatment can include surgery, radiation therapy, and/or chemotherapy.

KEY POINTS

• Salivary gland cancer is a rare disease in which malignant (cancer) cells form in the tissues of the salivary glands.
• Being exposed to certain types of radiation may increase the risk of salivary cancer.
• Signs of salivary gland cancer include a lump or trouble swallowing.
• Tests that examine the head, neck, and the inside of the mouth are used to diagnose salivary gland cancer.
• Certain factors affect treatment options and prognosis (chance of recovery).

Salivary gland cancer is a rare disease in which malignant (cancer) cells form in the tissues of the salivary glands.

The salivary glands make saliva and release it into the mouth. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. There are 3 pairs of major salivary glands:

• Parotid glands: These are the largest salivary glands and are found in front of and just below each ear. Most major salivary gland tumors begin in this gland.
• Sublingual glands: These glands are found under the tongue in the floor of the mouth.
• Submandibular glands: These glands are found below the jawbone.

Image Caption : Anatomy of the salivary glands. The three main pairs of salivary glands are the parotid glands, the sublingual glands, and the submandibular glands.

There are also hundreds of small (minor) salivary glands lining parts of the mouth, nose, and larynx that can be seen only with a microscope. Most small salivary gland tumors begin in the palate (roof of the mouth).

More than half of all salivary gland tumors are benign (not cancerous) and do not spread to other tissues.

Salivary gland cancer is a type of head and neck cancer.

Being exposed to certain types of radiation may increase the risk of salivary cancer.

Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Although the cause of most salivary gland cancers is not known, risk factors include the following:

• Older age.
• Treatment with radiation therapy to the head and neck.
• Being exposed to certain substances at work.

Signs of salivary gland cancer include a lump or trouble swallowing.

Salivary gland cancer may not cause any symptoms. It may be found during a regular dental check-up or physical exam. Signs and symptoms may be caused by salivary gland cancer or by other conditions. Check with your doctor if you have any of the following:

• A lump (usually painless) in the area of the ear, cheek, jaw, lip, or inside the mouth.
• Fluid draining from the ear.
• Trouble swallowing or opening the mouth widely.
• Numbness or weakness in the face.
• Pain in the face that does not go away.

Tests that examine the head, neck, and the inside of the mouth are used to diagnose salivary gland cancer.

The following procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health. The head, neck, mouth, and throat will be checked for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Image Caption : Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat, and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
  • Fine needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle. An FNA is the most common type of biopsy used for salivary gland cancer.
  • Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn’t look normal.
  • Surgery: If cancer cannot be diagnosed from the sample of tissue removed during an FNA biopsy or an incisional biopsy, the mass may be removed and checked for signs of cancer.

Because salivary gland cancer can be hard to diagnose, patients should ask to have the tissue samples checked by a pathologist who has experience in diagnosing salivary gland cancer.

Certain factors affect treatment options and prognosis (chance of recovery).

The treatment options and prognosis depend on the following:

• The stage of the cancer (especially the size of the tumor).
• The type of salivary gland the cancer is in.
• The type of cancer cells (how they look under a microscope).
• The patient's age and general health.

KEY POINTS

• After salivary gland cancer has been diagnosed, tests are done to find out if cancer cells have spread within the salivary gland or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The following stages are used for salivary gland cancers that affect the parotid, submandibular, and sublingual glands:
  • Stage 0 (carcinoma in situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV
• Minor salivary glands are staged differently from the parotid, submandibular, and sublingual glands.
• Salivary gland cancer can recur (come back) after it has been treated.

After salivary gland cancer has been diagnosed, tests are done to find out if cancer cells have spread within the salivary gland or to other parts of the body.

The process used to find out if cancer has spread within the salivary glands or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if salivary gland cancer spreads to the lung, the cancer cells in the lung are actually salivary gland cancer cells. The disease is metastatic salivary gland cancer, not lung cancer.

Image Caption : Tumor sizes. The size of a tumor may be compared to the size of a pea (1 cm), peanut (2 cm), grape (3 cm), walnut (4 cm), lime (5 cm), egg (6 cm), peach (7 cm), or grapefruit (10 cm).

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the salivary ducts or the small sacs that make up the salivary gland. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. The tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II

In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III

In stage III, one of the following is true:

• The tumor is larger than 4 centimeters and/or cancer has spread to soft tissue around the salivary gland; or
• The tumor is any size and cancer may have spread to soft tissue around the salivary gland. Cancer has spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller and cancer has not grown outside the lymph node.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

• Stage IVA:
  • Cancer has spread to the skin, jawbone, ear canal, and/or facial nerve. Cancer may have spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller and cancer has not grown outside the lymph node; or
  • The tumor is any size and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
    • to one lymph node on the same side of the head or neck as the tumor; the lymph node is 3 centimeters or smaller and cancer has grown outside the lymph node; or
    • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters but not larger than 6 centimeters and cancer has not grown outside the lymph node; or
    • to more than one lymph node on the same side of the head or neck as the tumor; the lymph nodes are 6 centimeters or smaller and cancer has not grown outside the lymph nodes; or
    • to lymph nodes on both sides of the head or neck or on the side opposite the primary tumor; the lymph nodes are 6 centimeters or smaller and cancer has not grown outside the lymph nodes.
• Stage IVB:
  • The tumor is any size and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
    • to one lymph node larger than 6 centimeters and cancer has not grown outside the lymph node; or
    • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters and cancer has grown outside the lymph node; or
    • to more than one lymph node on the same side of the head or neck as the tumor, on the side opposite the primary tumor, or on both sides of the head or neck; cancer has grown outside any of the lymph nodes; or
    • to one lymph node of any size on the side of the head or neck opposite the primary tumor; cancer has grown outside the lymph node;

      or

  • Cancer has spread to the bottom of the skull and/or surrounds the carotid artery. Cancer may have spread to one or more lymph nodes of any size on either or both sides of the head or neck and may have grown outside the lymph nodes.
• Stage IVC:
  • Cancer has spread to other parts of the body, such as the lungs.

Minor salivary glands are staged differently from the parotid, submandibular, and sublingual glands.

Minor salivary gland (small salivary glands lining parts of the mouth, nose, and larynx) cancers are staged according to where they were first formed, such as the oral cavity or sinuses.

Salivary gland cancer can recur (come back) after it has been treated.

The cancer may come back in the salivary glands or in other parts of the body.

There are different types of treatment for patients with salivary gland cancer.

Different types of treatment are available for patients with salivary gland cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Patients with salivary gland cancer should have their treatment planned by a team of doctors who are experts in treating head and neck cancer.

Your treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. Because the salivary glands help in eating and digesting food, patients may need special help adjusting to the side effects of the cancer and its treatment. The medical oncologist may refer you to other doctors who have experience and expertise in treating patients with head and neck cancer and who specialize in certain areas of medicine. These include the following:

• Head and neck surgeon.
• Radiation oncologist.
• Dentist.
• Speech therapist.
• Dietitian.
• Psychologist.
• Rehabilitation specialist.
• Plastic surgeon.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment for salivary gland cancer. A doctor may remove the cancer and some of the healthy tissue around the cancer. In some cases, a lymphadenectomy (surgery in which lymph nodes are removed) will also be done.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

• External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Image Caption: External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient’s head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.

• Special types of external radiation may be used to treat some salivary gland tumors. These include:

  • Fast neutron radiation therapy: Fast neutron radiation therapy is a type of high-energy external radiation therapy. A radiation therapy machine aims neutrons (tiny, invisible particles) at the cancer cells to kill them. Fast neutron radiation therapy uses a higher-energy radiation than the x-ray type of radiation therapy. This allows the radiation therapy to be given in fewer treatments.
  • Photon-beam radiation therapy: Photon-beam radiation therapy is a type of external radiation therapy that reaches deep tumors with high-energy x-rays made by a machine called a linear accelerator. This can be delivered as hyperfractionated radiation therapy, in which the total dose of radiation is divided into small doses and the treatments are given more than once a day.

External radiation therapy is used to treat salivary gland cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Treatment for salivary gland cancer may cause side effects.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Stage I Salivary Gland Cancer

Treatment for stage I salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

• Surgery with or without radiation therapy.
• Fast neutron radiation therapy.

If the cancer is high-grade, treatment may include the following:

• Surgery with or without radiation therapy.
• A clinical trial of chemotherapy.
• A clinical trial of a new local therapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage II Salivary Gland Cancer

Treatment for stage II salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy.
• Chemotherapy.

If the cancer is high-grade, treatment may include the following:

• Surgery with or without radiation therapy.
• Fast neutron or photon-beam radiation therapy.
• A clinical trial of radiation therapy and/or radiosensitizers.
• A clinical trial of chemotherapy.

Treatment of Stage III Salivary Gland Cancer

Treatment for stage III salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

• Surgery with or without lymphadenectomy. Radiation therapy may also be given after surgery.
• Radiation therapy.
• Fast neutron radiation therapy to lymph nodes with cancer.
• Chemotherapy.
• A clinical trial of fast neutron radiation therapy to the tumor.
• A clinical trial of chemotherapy.

If the cancer is high-grade, treatment may include the following:

• Surgery with or without lymphadenectomy. Radiation therapy may also be given after surgery.
• Fast neutron radiation therapy.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of radiation therapy and/or radiosensitizers.
• A clinical trial of chemotherapy.

Treatment of Stages IVA, IVB, and IVC Salivary Gland Cancer

Treatment of stage IVA, stage IVB, and stage IVC salivary gland cancer may include the following:

• Fast neutron or photon-beam radiation therapy.
• A clinical trial of chemotherapy with or without radiation therapy.

Treatment of Recurrent Salivary Gland Cancer

Treatment of recurrent salivary gland cancer may include the following:

• Radiation therapy.
• A clinical trial of a new treatment.