Salivary gland cancer
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What is salivary gland cancer?
Types of salivary gland cancer
Symptoms of salivary gland cancer
Causes of salivary gland cancer
Diagnosis of salivary gland cancer
Staging and grading of salivary gland cancer
Treatment for salivary gland cancer
After salivary gland cancer treatment
About our information
How we can help
Salivary gland cancer is rare type of head and neck cancer. The salivary glands are made up of different types of cells. The type of salivary gland cancer will depend on which type of cell it started in. Most tumours that develop in the salivary glands are non-cancerous (benign) but some are cancerous.
The salivary glands
The salivary glands make saliva (spit). This keeps your mouth moist, protects teeth and helps food slide down the gullet into the stomach. There are 3 main pairs of salivary glands. These are known as the major salivary glands. They are:
- parotid glands, which are at the sides of the mouth, just in front of the ears
- submandibular glands, which are under each side of the jawbone
- sublingual glands, which are under the floor of the mouth and below each side of the tongue.
There are many more very small glands throughout the lining of the nose, mouth and throat. These are known as the minor salivary glands.
The most common place for salivary gland cancer to start is in the parotid glands.
Treatment will depend on the type of salivary gland tumour.
Benign salivary tumours
There are different types of benign salivary gland tumours. Most benign tumours start in the parotid glands. The most common is a pleomorphic adenoma which is usually slow-growing.
Benign salivary gland tumours are removed using surgery. Even though they are benign, some benign salivary gland tumours may also need radiotherapy treatment if it is not possible to remove all of the tumour. This prevents possible complications caused by any remaining tumour cells.
Cancerous salivary tumours
- Muco-epidermoid cancer – these usually develop in the parotid gland but they can also develop in the submandibular glands. They can also develop in the minor salivary glands. They can be slow-growing, but some may grow more quickly.
- Adenoid-cystic cancer – these are one of the most common types of minor salivary gland cancer. They usually grow very slowly, but they may sometimes come back after treatment.
- Acinic cell carcinoma – develops in the acinar cells which produce saliva.
- Adenocarcinoma – rare cancers of the salivary gland. They develop in the lining cells of the body, in the major or minor salivary glands.
- Malignant mixed cancers – similar to a benign tumour of the salivary gland (pleomorphic adenoma).
Rarer types of salivary gland cancer include a squamous cell carcinoma.
The most common symptom of salivary gland cancer is a swelling on the side of the face, just in front of the ear or under the jawbone.
With certain symptoms, your dentist or GP should refer you to see a specialist within 2 weeks. This is called an urgent referral.
Salivary gland cancer symptoms may include:
- a swelling on the side of the face, just in front of the ear or under the jawbone – this is the most common symptom of salivary gland cancer
- numbness in part of your face
- pain where the swelling is
- drooping on one side of your face (facial palsy)
- difficulty opening your mouth fully
- redness over the skin of the gland.
These symptoms can be caused by other conditions. But it is important to have them checked by your doctor.
Salivary gland cancer can be treated more successfully when it is diagnosed early.
The exact causes of salivary gland cancers are not known. But there are risk factors that
which can increase the chances of developing it.
Your risk of developing salivary gland cancer may be higher if you have had:
- radiotherapy for Hodgkin lymphoma
- radiotherapy to the head and neck area as a child.
The risk of getting salivary gland cancer increases as you get older.
As with other cancers, salivary gland cancer is not infectious and cannot be passed onto other people.
We have general information about the causes and risk factors of head and neck cancer.
You usually start by seeing your GP. Sometimes symptoms may be picked up by your dentist. If they think your symptoms could be linked to cancer, they will refer you to a specialist head and neck doctor. You will usually see a specialist within 2 weeks. You may see an ear, nose and throat (ENT) specialist.
The specialist doctor will ask you about your symptoms and general health. They will check your mouth using a small mirror and light and examine the area where the lump is. If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.
You may have some of the following tests.
Ultrasound scan of the neckAn ultrasound uses soundwaves to produce a picture of your neck and lymph nodes. During the scan, they may use a fine needle to remove some cells from the lump into the syringe. This is called a fine needle aspiration biopsy.
Fine needle aspiration (FNA)To make a diagnosis your doctor needs to remove
sa small piece of tissue or some cells (biopsy) from the area that looks abnormal. An FNA is a type of biopsy using a very thin needle to remove a sample of cells.
You may also have this test to see whether there are any cancer cells in the lymph nodes in the neck. An ultrasound scan may be used to help the doctor to guide the needle into the correct area.
A doctor who specialises in analysing cells is called a pathologist. They look at the sample under a microscope to check for cancer cells.
We have more information about tests for head and neck cancer.
Further tests for salivary gland cancer
If salivary gland cancer is diagnosed, your doctor may want to do some further tests to find out more about the cancer. These tests may include:
CT scanA CT scan takes a series of x-rays, which build up a three-dimensional (3D) picture of the head and neck. For some types of salivary gland cancer, it is also used to scan the chest, abdomen and pelvic area.
Waiting for test results can be a difficult time. We have more information that can help.
The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging. The grade of the cancer gives an idea how quickly it may develop.
Knowing the stage and grade of the cancer helps the doctors plan the best treatment for you.
The staging systems most often used for salivary gland cancer are the TNM and number staging systems. The number staging system is less commonly used.
TNM staging system
TNM stands for tumour, node and metastases.
T describes the size of the tumour and whether it has grown into nearby tissues. It is numbered between 0 and 4 depending on the size and extent of the tumour.
- T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous.
- T1 tumours are smaller than 2cm and have not spread outside the salivary gland.
- T2 tumours are between 2 and 4cm and have not spread outside the salivary gland.
- T3 tumours are larger than 4cm and have spread outside the salivary gland.
- T4 tumours have spread into nearby skin, nerves or bones, or other areas of the head or skull.
N describes whether the cancer has spread to the neck lymph nodes.
M describes whether the cancer has spread to another part of the body. This is called metastatic cancer.
We have more information about the staging systems used for head and neck cancer.
Grading of salivary gland cancer
The grade describes how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
We have more information about grading for head and neck cancer.
Treatments for salivary gland cancer include surgery, radiotherapy and chemotherapy.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and the support you have. They will also talk to you about things to consider when treatment decisions before you agree (consent) to have treatment.
Your treatment depends on:
- the position of the cancer
- the type of cancer cell
- the stage and grade of the cancer
- your general health.
You will also usually be given advice about preparing for your treatment (sometimes called prehabilitation). This helps to improve your fitness and diet and help to get you ready mentally before treatment. If you smoke, it can also help you with stopping smoking.
For early-stage salivary gland cancer, you may only need one type of treatment. But sometimes 2 or more treatments are given, if the cancer is larger or has started to spread.
Treatment for salivary gland cancer may include:
Surgery is usually the main treatment for salivary gland cancer.
If the cancer is small and has not spread, the surgeon may only need to remove part or all of the salivary gland. Sometimes, the surgeon also needs to remove nearby tissue or bone if it is affected by the cancer. You may also have tissue, skin or bone taken from somewhere else in the body to rebuild the area (reconstructive surgery).
The surgeon sometimes needs to cut or remove part of the facial nerve, while being very careful to avoid possible nerve damage. Occasionally, the surgeon removes some of the neck lymph nodes during surgery, even if they do not show signs of cancer. This is to reduce the risk of the cancer coming back.
Depending on your operation, some people may have a feeding tube put in before or during surgery. It can usually be removed once you are able to swallow. If you are likely to need this, your team will discuss it with you before your operation.
We have more information about recovering from head and neck surgery.
Radiotherapy uses high-energy rays to destroy the cancer cells.
You may have radiotherapy after surgery to reduce the risk of the cancer coming back. It may also be used if it was not possible to remove all the cancer with surgery, or if the cancer comes back after treatment. Sometimes radiotherapy is the main treatment if surgery is not possible.
Radiotherapy may also be used to control symptoms, such as pain, if the cancer has spread to other areas of the body.
You may have side effects during and for a few weeks after radiotherapy. These usually get better slowly after treatment finishes.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be used to treat the symptoms of salivary gland cancer that has spread. You might have chemotherapy if you have advanced salivary gland cancer, and you cannot have surgery or radiotherapy.
You may have some treatments as part of a clinical trial.
After treatment, you will have regular follow-up appointments with your specialist doctor. These may continue for several years. You may also have regular follow-up appointments with your multidisciplinary team (MDT), including,a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist and sometimes a physiotherapist.
If you have any problems or notice new symptoms between appointments, let your doctor or nurse know as soon as possible.
Long-term or late effects
Some treatment side effects may take a long time to improve after treatment finishes, or they may become permanent. These are called long-term effects. Other side effects can develop months or even years after treatment has finished. These are known as late effects. We have more information about long-term and long-term and late effects of head and neck cancer treatment.
Head and neck cancer and its treatment can sometimes have an effect on your sex life.
If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.
Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
We have more information about:
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.
Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.
Direct services - salivary gland hub
We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
- Visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.
Further support and information is available through The Swallows. The Swallows is a national head and neck cancer support charity. It offers support to people affected by head and neck cancer, their carers, friends and relatives.
Support is also available from Salivary Gland Cancer UK. This charity supports people with rare salivary gland cancers, such as adenoid cystic carcinoma, ACC, and unknown carcinoma.
Below is a sample of the sources used in our salivary gland cancer information. If you would like more information about the sources we use, please contact us at email@example.com
British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed April 2022).
British Association of Head and Neck Oncologists. BAHNO Standards2020. Available from: bahno.org.uk/_userfiles/pages/files/final_bahno_standards_2020.pdf (accessed March 2022).
Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS- ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475. (accessed August 2022).
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over NICE guideline NG36 Published: 10 February 2016. Last updated: 06 June 2018 Available from: www.nice.org.uk/guidance/ng36/chapter/recommendations (accessed March 2022).
European Society for Medical Oncology. Matched targeted therapy in advanced salivary cancer. Published: 27 Feb 2020. Available from: www.esmo.org/oncology-news/matched-targeted-therapy-in-advanced-salivary-gland-carcinoma (accessed March 2022).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.