Head & Neck

Salivary Gland Cancer

Salivary glands make saliva to coat the throat and help digest food. They are found inside and near the mouth. Many different types of cancer and noncancerous tumors can develop in the salivary glands.

Two main types of salivary glands are found in the mouth: major and minor. Three sets of major salivary glands are on each side of the face (see figure below):

  • The parotid glands are the largest salivary glands and are located in front of the ears.
  • The submandibular glands are smaller and located below the jaw.
  • The sublingual glands are the smallest glands and are located under the floor of the mouth and below either side of the tongue.

Minor salivary glands are found in the lining of the lips and tongue, as well as on the roof of the mouth and inside the cheeks, nose, sinuses and larynx (voice box). These glands number in the hundreds and are too small to see without a microscope. Although tumors in these salivary glands are relatively rare, they are more often malignant (cancerous) than benign (noncancerous).

Unlike other head and neck cancers, doctors often give salivary glands a grade depending on how abnormal the cells look under a microscope. Grade 1 cancers (low grade) tend to grow slowly. Grade 2 cancers (intermediate grade) appear between grade 1 and grade 3 cancers. Grade 3 cancers (high grade) look very different from normal cells and can spread quickly.

Diagnosing salivary gland cancer

Salivary gland cancer is usually found during a routine dental visit or physical exam. Some symptoms of this cancer include a lump in the area of the ear, cheek, jaw, lip or inside the mouth; fluid draining from the ear; trouble swallowing or opening the mouth wide; numbness or weakness in the face; or pain in the face that does not go away.

If your doctor suspects you have salivary gland cancer, one or more of the following tests may be ordered: imaging tests, biopsy and/or fine needle aspiration procedure.

Staging

After diagnosing your salivary gland cancer, your doctor may order more tests, including magnetic resonance imaging (MRI) or computed tomography (CT), to stage the cancer.

The TNM staging system, developed by the American Joint Committee on Cancer (AJCC), is typically used to stage head and neck cancers. This system classifies the cancer by tumor (T), node (N) and metastasis (M). The T category describes the size and location of the primary tumor. The N category describes lymph node involvement, indicating whether the lymph nodes show evidence of cancer cells. The location of these lymph nodes is important because it shows how far the disease has spread. The pathologic N category (sometimes denoted as pN) describes how many lymph nodes are involved and the amount of tumor cells found in the nodes. The M category describes distant metastasis (spread of cancer to another part of the body), if any. Staging for the M category is mainly clinical; however, a new M subcategory may be given based on the presence of tumor cells that can only be detected using a microscope or molecular testing.

Once the cancer has been classified, an overall stage is assigned. The main stages are Stage 0 (or I) through Stage IV, where Stage 0 (also known as “in situ”) is a precursor of an invasive cancer. Stages I and II are confined to the local area where the cancer is found; Stage III has often spread to the regional lymph nodes or lymphatic channels; and Stage IV has spread to distant sites (such as the lung or bone). Even these basic stages are sometimes further divided into subgroups of tumors that have a similar prognosis (Stage IB, Stage IIIC, etc). This grouping allows doctors to more accurately predict survival outcome according to stage and to adjust the treatment to the stage or substage of the cancer. For certain cancers, the AJCC also recommends tumor genetic testing, which can help determine which treatments are likely to be most effective.

Although the original stage at diagnosis does not change, a doctor may reassess an individual’s cancer after treatment or if it has recurred, in a process known as restaging. This is rarely done but will likely involve the same diagnostic tests used for the original diagnosis. If a new stage is assigned, it’s often preceded by an “r” to denote that it’s a restage and different from the original stage given at diagnosis.

TNM classification for salivary gland cancer

Classification Definition
Tumor (T)
Tx Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
T1 Tumor is 2 centimeters (cm) (about ¾ inch) or less in diameter and does not extend to soft tissue.
T2 Tumor is more than 2 cm but not more than 4 cm in diameter and does not extend to soft tissue.
T3 Tumor is more than 4 cm and/or tumor extends to soft tissue.
T4a Moderately advanced disease. Tumor invades skin, mandible, ear canal and/or facial nerve.
T4b Very advanced disease. Tumor invades skull base and/or pterygoid plates and/or encases carotid artery.
Node (N)
Nx Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 Metastasis to a single lymph node on same side as tumor, 3 cm or less in diameter.
N2



  N2a

  N2b
  N2c
Metastasis to a single lymph node on same side as tumor, more than 3 cm but not more than 6 cm (a little less than 2½ inches) in diameter; or in multiple lymph nodes on same side, none more than 6 cm in diameter, or in lymph nodes on same side or both sides, none more than 6 cm in diameter.
Metastasis to a single lymph node on the same side as the tumor, more than 3 cm but not more than 6 cm in diameter.
Metastasis to multiple lymph nodes on same side as tumor, none more than 6 cm in diameter.
Metastasis to lymph nodes on opposite side or both sides of tumor, none larger than 6 cm in diameter.
N3 Metastasis to a lymph node, more than 6 cm in diameter.
Metastasis (M)
M0 No distant metastasis, has not spread to distant organs.
M1 Distant metastasis, has spread to distant organs.

 

Stages of salivary gland cancer

Stage T N M
I T1 N0 M0
II T2 N0 M0
III T3
T1
T2
T3
N0
N1
N1
N1
M0
M0
M0
M0
IVA T4a
T4a
T1
T2
T3
T4a
N0
N1
N2
N2
N2
N2
M0
M0
M0
M0
M0
M0
IVB T4b
Any T
Any N
N3
M0
M0
IVC Any T Any N M1

Treatment options

Common treatment options for salivary gland cancer include surgery, radiation therapy, chemotherapy and immunotherapy. The treatment option used will be based on the type, grade and stage of your cancer as well as your overall health, the impact to your speech, chewing and swallowing, and your own preferences.

Surgery

Surgery is often the main treatment for salivary gland cancers. Your doctor will consider the location and stage of your cancer to choose the appropriate surgery for you.

Most cancers in the salivary glands occur in the parotid gland. If the cancer has formed in the outside part of the gland, also known as the superficial lobe, your doctor may remove the lobe; this procedure is called a superficial parotidectomy. If the cancer has moved into deeper tissues, the operation to remove the entire gland is called a total parotidectomy, and it may require the removal of the facial nerve, which may affect facial movement.

Other surgeries include removal of the submandibular or sublingual glands, and, if the cancer has spread to lymph nodes, removal of the involved node or nodes, also called a lymph node dissection or lympadenectomy. Facial rejuvenation procedures may also be necessary.

Radiation therapy

Radiation therapy involves the use of high-energy particles such as X-rays to kill cancer cells. It can be used to treat some salivary gland cancers that can’t be removed by surgery or after surgery to kill any cancer cells that may have been left behind. Radiation therapy is sometimes used to help with symptoms of pain, bleeding or trouble swallowing in cases of advanced salivary gland cancer. Radiation therapy can be given as external and internal, but external is the type of radiation therapy used most often for salivary gland cancer.

Chemotherapy

Chemotherapy drugs, also called cytotoxic drugs, kill cells that divide quickly, such as cancer cells. Chemotherapy is considered a systemic treatment because the chemotherapy drugs travel throughout the body in the bloodstream. Treatment may involve the use of a single drug or multiple drugs in combination and is often given cycles. Chemotherapy may be combined with the radiation therapy; this treatment is known as chemoradiation therapy.

Immunotherapy

Immunotherapy uses the body’s own immune system to slow and kill cancer cells. This treatment approach involves the use of substances — made either by the body or in a laboratory — to identify cancer cells as a threat and target them for destruction.

Additional Resources

 

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