Salivary gland cancer

Cancer that starts in the salivary gland is rare. It is more common in people over 50, but can develop at any age.

The treatment you have will depend on the position, stage and grade of the cancer and your general health.

Salivary gland cancer can be treated with the following:

  • Surgery – this is usually the main treatment for salivary gland cancer.
  • Radiotherapy – this is often given after surgery to reduce the risk of the cancer coming back. It can be used to control the symptoms of salivary gland cancer.
  • Chemotherapy – this can also be used to control the symptoms of salivary gland cancer that has spread.

If surgery is not possible, radiotherapy can be given as the main treatment.

After your treatment, you will have regular check-ups. These will probably continue for several years. If you have problems or notice any new symptoms between these check-ups, it is important to tell your doctor as soon as possible.

What is salivary gland cancer?

Cancer that starts in the salivary gland is rare. In the UK, about 690 people are diagnosed with it each year. It is slightly more common in men than in women.

This information should be read with our information about head and neck cancers, which has further details about the tests and treatments mentioned below. If you have more questions, you can ask your doctor or nurse at the hospital where you are having your treatment.


The salivary glands

The salivary glands make saliva (spit). This keeps your mouth moist and helps food slide down the gullet into the stomach.

The salivary glands
The salivary glands

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The largest salivary glands are the:

  • sublingual glands – 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 nose, mouth and throat. These are known as the minor salivary glands.


Causes and risk factors

Doctors do not know what causes salivary gland cancer, but several factors can increase your risk of developing it. Having a particular risk factor does not mean you will definitely get cancer. And sometimes people without any known risk factors can develop cancer.

Cancer in the salivary gland can develop in people of any age, but it is more common in people over 50.

People who have had radiotherapy before for another cancer in the head and neck area, or who have had Hodgkin lymphoma, have a slightly increased risk.

The viral infection HIV (human immunodeficiency virus) may increase the risk of developing salivary gland cancer.


Symptoms of salivary gland cancer

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. Some people also have pain, numbness or drooping on one side of their face (facial palsy).

These symptoms can be caused by other conditions, but it is important to have them checked by your doctor.


Diagnosing salivary gland cancer

You usually start by seeing your GP. If they are unsure what the problem is or think that your symptoms could be caused by cancer, they will refer you to a hospital specialist.

At the hospital, the specialist doctor will ask you about your symptoms and general health before examining you. They will check your mouth using a small mirror and light. They may use a nasoendoscope, which is a very thin, flexible tube with a light and camera at the end. The doctor will gently put this up your nose to get a better view of the back of your mouth and throat.

To make a diagnosis, the doctor may put a fine needle into the swelling or abnormal area and withdraw a sample of cells into a syringe. This is called a fine needle aspiration. It is a quick test but may be uncomfortable.

A pathologist (doctor who specialises in analysing cells) examines the cells under a microscope to look for signs of cancer.


Further tests for salivary gland cancer

These tests may be used to help diagnose salivary gland cancer and to check whether it has spread:


Ultrasound scan

This test uses sound waves to build up a picture of an area of your head or neck on a computer screen. The scan is painless and only takes a few minutes. The person doing the scan will spread some gel onto your face or neck. They then pass a small device, which produces sound waves, over the area.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You’ll probably be able to go home as soon as the scan is over.

MRI scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it's safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you've ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

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, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you'll 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. It's also noisy, but you'll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


Staging and grading salivary gland cancer

Staging

The stage of a cancer describes its size and whether it has spread. Knowing the stage of the cancer helps the doctors decide on the best treatment for you. The two most commonly used staging systems for salivary gland cancer are the TNM and the number system.

TNM staging system

  • T describes the size of the tumour and whether it has grown into nearby tissues. The tumour size is numbered from 1 to 4.
  • N describes whether the cancer has spread to the lymph nodes. The lymph nodes are part of your body’s immune system, which protects you from infection and disease. N0 means that there is no cancer in the lymph nodes. N1, N2 or N3 means there are cancer cells in the neck lymph nodes.
  • M describes whether the cancer has spread to another part of the body. This is called secondary or metastatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to organs such as the liver or lungs.

Number staging system

Salivary gland cancer can also be given a number stage from 1 to 4. Stage 1 is when the cancer is at an early stage. It is usually small in size and has not spread. Stage 4 means the cancer is at a more advanced stage. It may have spread to other parts of the body.

Talking about staging

To keep things simple, your doctor may use the following words to describe the stage of the cancer:

  • Early or local – to describe cancer that has not spread.
  • Locally advanced – to describe cancer that has spread into nearby tissues or lymph nodes.
  • Local recurrence – to describe cancer that has come back in the head or neck after treatment.
  • Advanced or widespread – to describe cancer that has spread to distant organs.

Grading

The grade of a cancer gives the doctor an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells through a microscope to find the grade of the cancer.

  • Grade 1 – the cancer cells tend to grow slowly and look quite similar to normal cells.
  • Grade 2 and 3 – the cancer cells look more abnormal.
  • Grade 4 – the cancer cells tend to grow more quickly and look very abnormal.


Treatment for salivary gland cancer

Treatment overview

Your treatment will depend on the position, stage and grade of the cancer and your general health. The main treatment for salivary gland cancer is usually surgery. Radiotherapy is often given after surgery to reduce the risk of the cancer coming back. It may also be given if the surgeon was not able to remove all the cancer or if the cancer comes back after treatment. Sometimes radiotherapy can be given as the main treatment if surgery is not possible.

Radiotherapy or chemotherapy can also be used to control the symptoms of salivary gland cancer that has spread.

Surgery

Surgery is used to remove all or as much of the cancer as possible. The type of surgery you have depends on the size and position of the tumour. If the cancer is small and has not spread, the surgeon may only remove the salivary gland. But sometimes they will also need to remove nearby tissue or bone if it is affected by the cancer.

The thought of having any type of surgery to your head and face can be frightening. Your surgeon will explain what to expect and answer any questions before your operation. Your surgery is planned carefully by a team of specialist surgeons. They will try to avoid changes to your appearance or to areas of your mouth or face that help you talk, swallow or eat.

If your surgery involves removing any of these areas, the surgeon may rebuild them with tissue, skin or bone taken from somewhere else in your body. If part of the roof of your mouth is removed, the surgeon will fit a special piece of plastic (called an obturator) into the missing area. This covers any gaps in the roof of the mouth to help you speak and eat.

The surgeon usually removes some of your 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.

After surgery

How long you stay in hospital depends on the operation you have. Some people will have a small operation at a hospital day surgery and go home the same day. But if your surgery is more complicated, you might stay in hospital for up to three weeks. You may be looked after in a high-dependency unit or intensive care for a while after the operation. Your doctor or nurse can explain more about this.

As you recover, you may see a dietitian and speech and language therapist (SALT) if you need help to cope with any changes to your speech or swallowing. If you have an obturator, you will see a restorative dentist regularly. They will make sure it fits well as your mouth heals.

Side effects of surgery

These will depend on the type of operation you have. Your speech, swallowing or your sense of taste and smell might be affected. Some operations may leave scars or a change in your appearance.

It is important to prepare for this kind of surgery. You can discuss your operation fully with your surgeon so that you know what to expect and how it will affect you. You may also find some of these organisations helpful:

  • Changing Faces supports people who have conditions or injuries which affect their appearance. It offers a skin camouflage service for people living with scarring or a skin condition that affects their confidence.

Telephone: 0300 012 0275 (Mon–Fri, 10am–4pm)

email: info@changingfaces.org.uk

  • Let’s Face It is a support network for people with facial disfigurements.

Telephone: 01843 491291

email: chrisletsfaceit@aol.com

  • Saving Faces has an expert patient helpline that puts people in touch with someone who has had the same condition or similar surgery.

Telephone: 07792 357972 (Mon–Fri, 9am–5pm)

email: helpline@savingfaces.co.uk

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

You have treatment in small doses (called fractions) over five to seven weeks from a radiotherapy machine similar to an x-ray machine. It is usually given as a daily dose from Monday to Friday, with a break at weekends. Radiotherapy does not make you radioactive. The treatment itself only takes a few minutes and is not painful.

When you have radiotherapy, it is important to keep still so that the treatment is given to exactly the right area. To make sure you keep your head still, you may need to wear a see- through plastic mask during your treatment. The mask should not be uncomfortable and does not affect your breathing. If you are worried about the mask, let your radiotherapy team know so they can help.

Radiotherapy may also be used to control symptoms, such as pain, if the cancer has spread to other areas of the body. For this, you might only need a few days of treatment or just a single dose.

Side effects of radiotherapy

You may develop side effects during radiotherapy. These usually get better gradually over a few weeks or months after treatment finishes. The main side effects are tiredness (fatigue) and difficulty swallowing.

Your radiotherapy team will tell you more about what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Most side effects get better after treatment ends, but many people have a dry mouth after their treatment is over. Your doctor or nurse can tell you what can help. Radiotherapy to the head and neck can cause other long-term effects. These are not as common, but can happen months or even years after your treatment.

Our general information on head and neck cancers has more details about radiotherapy, coping with side effects and the long-term effects.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is sometimes given to treat the symptoms of salivary gland cancer that has spread.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain any treatment you are offered and what to expect. Tell them about any side effects you have during treatment. They can often prescribe drugs to help.

Chemotherapy can reduce the number of white cells in your blood. This will make you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause side effects such as:

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Follow-up

You will have regular appointments with your cancer specialist after your treatment. But if you have any new symptoms or problems in between your appointments, you can see your GP or contact your specialist doctor or nurse.

Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are done on patients are known as clinical trials.

Research into treatments for salivary gland cancer is ongoing and advances are being made. But because this type of cancer is rare, there may not always be a trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. 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.


Your feelings

You may have many different emotions, from shock and disbelief to fear and anger. At times, these feelings can be overwhelming and hard to control. But they are natural and it is important to be able to express them.

Everyone has their own way of coping. Some people prefer to keep their feelings to themselves. Some find it helps to talk to family or friends, while others get help from people outside their situation. Sometimes it is helpful to share your experiences at a local cancer support group. You may want to talk to our cancer support specialists free on 0808 808 00 00, Monday to Friday, 9am to 8pm.

There is no right or wrong way to deal with this, but help is available if you need it. Talking to other people in a similar position may help you feel less alone. Our online community is also a good place to meet people who may be in a similar situation.

Some of these organisations may be able to help you cope with your feelings:

  • The Mouth Cancer Foundation gives information and support through their website and telephone helpline to people affected by head and neck cancers.

Telephone: 01924 950 950 (Mon–Fri, 9am–5pm)

email: info@mouthcancerfoundation.org

  • cancer52 – the common voice for less common cancers aims to promote improved diagnosis, treatment and support for those affected by rare and less common cancers.

email: info@cancer52.org.uk

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Organising

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Treating

head and neck cancers and what to expect

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