Salivary gland cancer
Cancers affecting the salivary glands are rare, making up less than 1 out of every 100 cancers diagnosed in the UK. They can occur at any age, but are more common in people over 50.
You may find it helpful to read this information alongside our general information about head and neck cancers
There are different types of salivary gland cancer depending on the type of cell that has become cancerous.
The salivary glands make saliva (spit). This keeps your mouth moist and helps food slide down the gullet into the stomach. The largest salivary glands are:
sublingual glands - found underneath the tongue
parotid glands - at the sides of the mouth just in front of the ears
submandibular glands - under the jawbone.
There are also many more tiny glands in the lining of the mouth and throat. These don't have individual names but are known as the minor salivary glands.
Cancers affecting the salivary glands are rare, with approximately 550 new cases in the UK each year. They can occur at any age, but are more common in people over 50.
There are different types of salivary gland cancer, depending on the type of cell that has become cancerous.
Causes of salivary gland cancer
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Like many other types of cancer, the exact causes of salivary gland cancer are unknown. Non-cancerous (benign) tumours of the salivary glands are more common than cancerous (malignant) tumours.
Tumours affecting the salivary glands are not infectious and can't be passed on to other people. They are not caused by an inherited faulty gene, so the relatives of someone with salivary gland cancer aren't likely to develop it.
Signs and symptoms of salivary gland cancer
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The most common symptom of salivary gland cancer is a swelling on the side of the face, just in front of the ears, or under the jawbone. Some people also have some numbness and drooping on one side of their face (facial palsy).
These symptoms may be caused by conditions other than cancer, and most people with these symptoms won't have salivary gland cancer. However, like most cancers, salivary gland cancers are best treated when diagnosed at an early stage. You should tell your GP about these symptoms if they don't improve over a few days.
How salivary gland cancer is diagnosed
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Your GP will examine you and arrange for any tests that may be necessary. You will be referred to a hospital specialist for these tests, and for expert advice and treatment. The specialist at the hospital will ask about your general health and any previous medical problems, before examining you. They may arrange blood tests to check your general health. The following tests are commonly used to diagnose salivary gland cancer:
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won’t harm anyone you come into contact with. You'll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have the scan.
Before the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You'll be able to hear and speak to the person operating the scanner.
The doctor may use a fine needle and syringe to take a sample of cells from the affected area to examine under a microscope. Alternatively, a small piece of tissue may be taken from the area. This procedure is usually performed under a general or local anaesthetic.
Staging of salivary gland cancer
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The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors decide on the most appropriate treatment for you.
The most commonly used staging system is called the TNM system:
T refers to the size or position of the primary tumour (where the cancer first starts in the body).
N refers to which lymph nodes are affected, if any.
M refers to metastatic disease (when the cancer has spread to other parts of the body).
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.
The exact details of the T, N and M will depend on the salivary glands affected.
As well as TNM staging, you’ll probably hear the doctors use a number staging system. There are usually 3 or 4 number stages for each cancer type.
Stage 1 describes a cancer at an early stage, when it is usually small and hasn’t spread. Stage 4 describes cancer that is more advanced and has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.
The number stages are made of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0. Number stages may be subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer might differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes
‘Local recurrence’ means the cancer has come back in the same area after treatment
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
Your doctors can give you more information about the stage of your particular cancer.
Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop.
Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
Treatment for salivary gland cancer
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Salivary gland cancers can start in various cells within the salivary glands and may be slow or fast-growing. The type of treatment you have will depend on a number of things, including the position of the cancer, the exact type of cancer, and your general health. The following treatments may be used alone or in combination.
Surgery may be used to remove the salivary gland. Your doctor will discuss the operation with you beforehand and will tell you about any possible side effects. The doctor may sometimes recommend surgery to remove any affected lymph nodes in the neck. Some types of surgery may cause changes in your appearance. Your doctor will talk to you more about how surgery might affect you.
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is given from a radiotherapy machine, much like an x-ray machine. It does not make you radioactive. It’s used to treat salivary gland cancers that can't be completely removed by surgery or if surgery is likely to cause unacceptable changes in your appearance. It may also be used after surgery if there is a risk the cancer may come back (adjuvant radiotherapy).
During and after radiotherapy treatment to the salivary glands, your salivary glands will produce less saliva and this may affect your eating. It is important to see a dentist regularly if you have a dry mouth.
It's very important to keep your mouth clean, and your doctors and nurses will advise you about this. It can be helpful to visit a dentist before starting radiotherapy to make sure your mouth is as healthy as possible. This can help to prevent side effects developing in the future. If you need to have any teeth removed before treatment, you should wait at least two weeks before starting radiotherapy to the salivary glands. If you need to have a tooth removed after treatment, this should be done by a hospital specialist.
Side effects of radiotherapy usually decrease gradually once the treatment has ended. Some people find that their salivary glands are permanently altered. It's important to discuss this with your doctor and dentist, as it is often possible to find ways of reducing any problems. Your doctor or a dietitian at the hospital may be able to give you further advice if this problem occurs.
This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Although chemotherapy is helpful for many types of cancer, it’s not very effective in treating salivary gland cancers and is only used occasionally.
Cancer research trials (clinical trials)
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You may be asked to take part in a cancer research trial. For example, you may be offered chemotherapy treatment as part of a trial. Before any trial is allowed to take place it must have been approved by the ethics committee, which checks that the trial is in the interest of patients.
Your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part or to withdraw from a trial at any stage. You will still receive the best standard treatment available.
Follow-up for salivary gland cancer
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You will have regular check-ups once your treatment has finished. These will often continue for several years, regularly at first and then less often. Let your doctor know if you have any problems or notice any symptoms between visits.
When you are diagnosed with cancer, and during your treatment, you are likely to experience a number of different emotions, from shock and disbelief to fear and anger. At times emotions can be overwhelming and hard to control. These feelings are natural and it is important to be able to express them.
Everyone has their own way of coping with difficult situations; some people find it helpful to talk to family or friends, while others prefer to seek help from people who are less involved with their situation. Some people prefer to keep their feelings to themselves.
There is no right or wrong way to cope, but help is available if you need it. Contact our cancer support specialists if you would like more information about counselling.
Changing Faces provides free help, support and information for people with a facial disfigurement.
Let's Face It
Let's Face It provides support, information, social activities, and advice on camouflage makeup for people with facial disfigurement.
This information has been compiled using information from a number of reliable sources, including:
DeVita, et al. Cancer: Principles and Practice of Oncology. 7th edition. 2005. Lippincott Williams and Wilkins.
Genden E, Varvares M. Head and Neck Cancer: An Evidence-Based Team Approach. 2008. Thieme Publishers.
Improving Outcomes in Head and Neck Cancers. November 2004. National Institute for Health and Clinical Excellence (NICE).
J Tobias and D Hochauser. Cancer and its management. 6th edition. 2010. Wiley Blackwell.
Raghaven D, et al. Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
UpToDate. Salivary gland tumours: Treatment of locoregional disease. (accessed October 2012 ).
With thanks to: Dr Amen Sibtain, Consultant Clinical Oncologist; and the people affected by cancer who reviewed this edition.
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