General Information About Salivary Gland Cancer

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 glandtumors begin in thisgland.
• Sublingual glands: These glands are found under the tongue in the floor of the mouth.
• Submandibular glands: These glands are found below the jawbone.

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. People who think they may be at risk should discuss this with their doctor. Although the cause of most salivary gland cancers is not known, risk factors include the following:

• Older age.
• Treatment withradiation therapyto the head and neck.
• Being exposed to certain substances at work.

Possible signs of salivary gland cancer include a lump or trouble swallowing.

Salivary gland cancer may not cause any symptoms . It is sometimes found during a regular dental check-up or physical exam. Symptoms caused by salivary gland cancer also may be caused by other conditions. A doctor should be consulted if any of the following problems occur:

• A lump (usually painless) in the area of the ear, cheek, jaw, lip, or inside the mouth.
• Fluiddraining 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 detect (find) and 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 anx-ray machine. Adye may beinjected into avein or swallowed to help theorgansor tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• PET scan (positron emission tomography scan): A procedure to findmalignant tumorcells in the body. A small amount ofradioactive glucose (sugar) is injected into a vein. The PETscannerrotates 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.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called asonogram. The picture can be printed to be looked at later.
• Endoscopy : A procedure to look at organs and tissues inside the body to check forabnormal areas. For salivary gland cancer, anendoscopeis 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.
• Fine needle aspiration (FNA) biopsy : The removal of tissue or fluid using a thin needle. Apathologistviews the tissue or fluid under a microscope to look for cancer cells.

Because salivary gland cancer can be hard to diagnose , patients should ask to have biopsy 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 (chance of recovery) depend on the following:

• Thestageof 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.

Stages of Salivary Gland Cancer

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 anx-ray machine. Adye may beinjected into avein or swallowed to help theorgans ortissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Throughtissue . Cancerinvadesthe surrounding normal tissue.
• Through thelymph system . Cancer invades the lymph system and travels through thelymph vesselsto other places in the body.
• Through theblood . Cancer invades theveins andcapillariesand travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis . The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for major salivary gland cancers:

Pea, peanut, walnut, and lime show tumor sizes.

Stage I

In stage I , 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:

• Thetumor is not larger than 4centimeters and has spread to a singlelymph nodeon the same side as the tumor and the lymph node is 3 centimeters or smaller.
• The tumor is larger than 4 centimeters and/or has spread tosoft tissue around the affectedgland. Cancer may have spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV

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

• Stage IVA:
  • Thetumor may be any size and may have spread tosoft tissue around the affectedgland .Cancer has spread to a singlelymph node on the same side as the tumor and the lymph node is larger than 3centimeters but not larger than 6 centimeters, or has spread to more than one lymph node on either or both sides of the body and the lymph nodes are not larger than 6centimeters; or
  • Cancer has spread to the skin, jawbone, ear canal, and/or facialnerve, and may have spread to one or more lymph nodes on either or both sides of the body. The lymph nodes are not larger than 6 centimeters.
• Stage IVB:
  • Thetumor may be any size and may have spread to softtissue around the affectedgland .Cancer has spread to alymph node larger than 6centimeters; or
  • Cancer has spread to the base of the skull and/or thecarotid artery, and may have spread to one or more lymph nodes of any size on either or both sides of the body.
• Stage IVC:
  • Thetumor may be any size and may have spread tosoft tissue around the affectedgland , to the skin, jawbone, ear canal, facialnerve , base of the skull, orcarotid artery , or to one or morelymph nodeson either or both sides of the body. Cancer has spread to distant parts of the body.

Salivary gland cancers are also grouped by grade . The grade of a tumor tells how fast the cancer cells are growing, based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

Minor salivary gland cancers are staged according to where they were first found in the body.

Recurrent Salivary Gland Cancer

Recurrent salivary gland cancer is cancer that has recurred (come back) after it has been treated. Recurrent salivary gland cancer may come back in the salivary glands or in other parts of the body.

Treatment Option Overview

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 necksurgeon.
• 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.

Even if 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 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. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Special types of 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 tiny, invisible particles, called neutrons, 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 : A type of radiation therapy that reaches deep tumors with high-energy x-rays made by a machine called alinear accelerator . This can be delivered ashyperfractionated radiation therapy , in which the totaldoseof radiation is divided into small doses and the treatments are given more than once a day.

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). When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved for Head and Neck Cancer for more information. (Salivary gland cancer is a type of head and neck cancer.)

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 Web site.

Radiosensitizers

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

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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

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. This is sometimes called re-staging.

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 Options by Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

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 withoutradiation therapy.
• Fast neutron radiation therapy.

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

• Surgery with or without radiation therapy.
• Aclinical trial ofchemotherapy.
• A clinical trial of a newlocal therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

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 withoutradiation therapy.
• Radiation therapy.
• Chemotherapy.

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

• Surgery with or without radiation therapy.
• Fast neutron orphoton-beam radiation therapy.
• Aclinical trial of radiation therapy and/orradiosensitizers.
• A clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

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 withoutlymphadenectomy .Radiation therapymay also be given after surgery.
• Radiation therapy.
• Fast neutron radiation therapy tolymph nodeswith cancer.
• Chemotherapy.
• Aclinical trial of fast neutron radiation therapy to thetumor.
• 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 aspalliative therapy to relievesymptoms and improvequality of life.
• A clinical trial of radiation therapy and/orradiosensitizers.
• A clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IV Salivary Gland Cancer

Treatment of stage IV salivary gland cancer may include the following:

• Fast neutron orphoton-beam radiation therapy.
• Aclinical trial ofchemotherapy with or withoutradiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Salivary Gland Cancer

Treatment of recurrent salivary gland cancer may include the following:

• Radiation therapy.
• Aclinical trialof a new treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Salivary Gland Cancer

For more information from the National Cancer Institute about salivary gland cancer, see the following:

• Head and Neck Cancer Home Page
• Oral Complications of Chemotherapy and Head/Neck Radiation
• Drugs Approved for Head and Neck Cancer
• Head and Neck Cancer: Questions and Answers

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer
• Understanding Cancer Series: Cancer
• Cancer Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer: Supportive and Palliative Care
• Questions to Ask Your Doctor About Cancer
• Cancer Library
• Information For Survivors/Caregivers/Advocates

Changes to This Summary (10 / 21 / 2011)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

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Last Revised: 2011-10-21

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