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 cancerous (malignant) and noncancerous (benign) 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 than benign.

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, tests will be done to confirm the diagnosis.

Staging

After diagnosing your salivary gland cancer, your doctor will stage the disease using the TNM (tumor, node, metastasis) system to determine the extent of the cancer and its location. Your doctor may also order more tests to find out if cancer cells have spread from the salivary gland to other parts of the body.

Unlike other head and neck cancers, doctors often give salivary gland cancers a grade as well as a stage. The stage determines the extent of the cancer, where it is located and if it has spread. The grade indicates how abnormal the cells look under a microscope. Low grade cancers tend to grow slowly. Intermediate grade cancers behave somewhere between low and high grade cancers. High grade cancers look very different from normal cells and can spread quickly.

Treatment Options

Standard 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. Be sure to talk to your doctor and/or health care team about the benefits and risks of each type of treatment so that you are better informed for making shared treatment decisions.

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 extends to deeper tissues, the operation to remove the entire gland is called a total parotidectomy, and it may require removal of the facial nerve, which may affect facial movement.

Other surgeries include removal of the submandibular or sublingual glands, and a lymph node dissection (lymphadenectomy) to remove nodes that may be involved by cancer.

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 externally or internally, but it is usually given externally for salivary gland cancers.

Chemotherapy

Chemotherapy drugs kill cells that divide quickly, such as cancer cells. Chemotherapy is considered a systemic treatment because the 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 in cycles. Chemotherapy may be combined with radiation therapy; this treatment is known as chemoradiation therapy. In chemoradiation, the chemotherapy drug used helps the cancer cells become more sensitive to the radiation, allowing the radiation to kill more of them.

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. Immunotherapy for head and neck cancers involves the use of drugs known as immune checkpoint inhibitors. These inhibitors may be given with or without chemotherapy. Immunotherapy may be an option for salivary gland cancer that has stopped responding to chemotherapy.

Other treatments continue to be evaluated in clinical trials. Ask your doctor if a clinical trial is an option for you.

Classifying Salivary Gland Cancer

Classification Definition
Tumor (T)
TX Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
Tis Carcinoma in situ.
T1 Tumor 2 cm or smaller in greatest dimension without extraparenchymal extension (spread to surrounding tissues).
T2 Tumor larger than 2 cm but not larger than 4 cm in greatest dimension without extraparenchymal extension (spread to surrounding tissues).
T3 Tumor larger than 4 cm and/or tumor having extraparenchymal extension (spread to surrounding tissues).
T4 Moderately advanced or very advanced disease.
  T4a Moderately advanced disease.
Tumor invades skin, mandible (lower jaw), ear canal, and/or facial nerve.
  T4b Very advanced local 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 in a single ipsilateral (on the same side) lymph node, 3 cm or smaller in greatest dimension and ENE*(-).
N2 Metastasis in a single ipsilateral (on the same side) lymph node, 3 cm or smaller in greatest dimension and ENE*(+);
or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-);
or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(-);
or in bilateral (on both sides) or contralateral (on the opposite side) lymph node(s), none larger than 6 cm in greatest dimension, ENE(-).
  N2a Metastasis in single ipsilateral (on the same side) node 3 cm or smaller in greatest dimension and ENE*(+);
or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-).
  N2b Metastases in multiple ipsilateral (on the same side) nodes, none larger than 6 cm in greatest dimension and ENE*(-).
  N2c Metastases in bilateral (on both sides) or contralateral (on the opposite side) lymph node(s), none larger than 6 cm in greatest dimension and ENE*(-).
N3 Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE*(-);
or metastasis in a single ipsilateral (on the same side) node larger than 3 cm in greatest dimension and ENE(+);
or multiple ipsilateral, contralateral (on the opposite side) or bilateral (on both sides) nodes, any with ENE(+);
or a single contralateral node 3 cm or smaller and ENE(+).
  N3a Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(-).
  N3b Metastasis in a single ipsilateral (on the same side) node larger than 3 cm in greatest dimension and ENE*(+);
or multiple ipsilateral, contralateral (on the opposite side) or bilateral (on both sides) nodes, any with ENE(+);
or a single contralateral node 3 cm or smaller and ENE(+).
Metastasis (M)
M0 No distant metastasis.
M1 Distant metastasis.
*Extranodal extension (ENE) refers to cancer cells that have spread beyond the lymph node into surrounding tissues.

Staging Salivary Gland Cancer

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
III T3
T0, T1, T2, T3
N0
N1
M0
M0
IVA T4a
T0, T1, T2, T3, T4a
N0, N1
N2
M0
M0
IVB Any T
T4b
N3
Any N
M0
M0
IVC Any T Any N M1

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer Science+Business Media.

Additional Resources

 

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