Salivary gland cancer

The salivary glands make saliva (spit). The most common symptom of a salivary gland cancer is a swelling on the side of the face, just in front of the ear or under the jaw bone.

If you have symptoms, it is important to have them checked by your GP. They may refer you to a specialist for tests. These may include a test to examine the back of your mouth and throat closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.

The main treatment for salivary gland cancer is usually surgery. You may have radiotherapy after surgery to reduce the risk of the cancer coming back. Sometimes radiotherapy is given as the main treatment.

Your doctor will discuss with you the best treatment for you. Surgery may affect your speech or how you swallow. Side effects of radiotherapy include a dry or sore mouth, thick saliva and difficulty eating.

Your hospital team will tell you more about what to expect. There are lots of things that can help you manage side effects during and after treatment.

What is salivary gland cancer?

Most tumours that develop in the salivary gland are non-cancerous (benign).

Salivary gland cancer is rare. It can affect people of any age, but is more common in people aged over 50. It is more common in women than men.

Salivary gland cancers can be made up of different cell types.


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 biggest salivary glands 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 or the mouth and below each side of the tongue.

There are many more tiny glands in 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 develop is in the parotid glands.

The salivary glands
The salivary glands

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Causes and risk factors of salivary gland cancer

Salivary gland cancer is a rare cancer. The exact causes are not known.

Certain things (risk factors) can increase your risk of developing it. Having a risk factor does not mean you will definitely develop salivary gland cancer. And if you do not have any risk factors, it does not mean you will not get cancer.

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.

Your risk of getting salivary gland cancer increases as you get older.


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. This may be a painless swelling

Other symptoms include:

  • numbness in part of your face
  • pain where the swelling is
  • ear ache
  • drooping on one side of your face (facial palsy)
  • difficulty opening your mouth fully.

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.


How salivary gland cancer is diagnosed

You usually start by seeing your GP. They will examine your mouth closely.

They will refer you to a hospital specialist if:

  • they think that your symptoms could be caused by cancer
  • they are not sure what the problem is.

The specialist doctor will ask you about your symptoms and general health. They will check your mouth using a small mirror and light. They will also examine the area where the lump is and arrange for you to have some tests.

You may have some of the following tests.

Ultrasound scan

This test uses sound waves to build up a picture of your head or neck on a computer screen.

The scan is painless and only takes a few minutes. The doctor will put some gel on to your face or neck and move 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 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may 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 an 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 is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.

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

MRI scan

An MRI scan 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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Fine needle aspiration (FNA)

To make a diagnosis, your doctor may put a fine needle into the swelling or abnormal area. They then withdraw a sample of cells or some fluid into a syringe. This is called a fine needle aspiration. It is a quick and simple test that you can have done as an outpatient. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area to be tested.

You do not usually need a local anaesthetic to numb the area. It is common to have some bruising or soreness in the area the sample was taken from. The soreness may last for a week or so. Taking mild painkillers should help. Ask your nurse or doctor what they recommend.

After the test, a doctor who specialises in analysing cells (pathologist) will look at the sample under a microscope to check for cancer cells.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging for salivary gland cancer

The stage of a cancer describes its size and whether it has spread beyond where it started. Knowing the stage helps the doctors decide on the best treatment for you.

The most commonly used staging systems for salivary gland cancer are the TNM and number staging systems.

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. A T1 salivary gland tumour is small and has not spread outside the gland. A T4 salivary gland tumour has spread into nearby skin, bones, nerves or other areas of the head or skull.
  • N describes whether the cancer has spread to the neck lymph nodes. N0 means that no lymph nodes are affected by cancer. N1, N2 or N3 means that there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to distant organs, such as the lungs or liver.

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 in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading for salivary gland cancer

The grade of a cancer gives the doctor an idea of how quickly it may develop. Knowing the grade can help them plan the best treatment. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

  • Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 – or high grade – the cancer cells look very different to normal cells and may grow more quickly.


How salivary gland cancer is treated

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.

Your treatment type depends on:

  • the position of the cancer
  • the type of cancer cell
  • the stage and grade of the cancer
  • your general health.

Your specialist doctor or nurse will explain the best treatment for you and any likely side effects.


Surgery for salivary gland cancer

Surgery is used to remove all or as much of the cancer as possible. The type of surgery you have and how the cancer is removed 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.

Sometimes, the surgeon also needs to remove nearby tissue or bone if it is affected by the cancer. 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.

Sometimes, the surgeon needs to cut or remove part of the facial nerve. They try to avoid nerve damage, but sometimes this is the only way to remove all the cancer. Occasionally, the surgeon takes out 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.

Your doctor will explain the operation to you beforehand. You will be able to ask any questions you have about it.

After the operation

How long you stay in hospital depends on the operation you have. Some people have a small operation at a hospital day-surgery unit and go home the same day. But if your surgery is more complicated, you might stay in hospital longer. Rarely, you may be looked after in a high-dependency unit or intensive care if you need a more complicated operation. Your specialist doctor can tell you more about the type of operation and how long you may need to stay in hospital.

As you recover, you may see a dietitian and speech and language therapist (SLT) to help you cope with any changes to your speech or how you swallow. You will also need to see a dentist regularly.

We have more information about what to expect before and after surgery.

Effects of surgery

Depending on the type of operation you have, it might:

  • affect your speech
  • affect your sense of taste and smell
  • affect how you swallow
  • leave scars or change your facial appearance.

It can be difficult to prepare for and cope with this kind of surgery. A team of specialist surgeons carefully plans your surgery. It is important to discuss your operation fully with your surgeon, so you know what to expect and how it will affect you. Your surgeon can also tell you what support is available.

You can read more in our general information about head and neck cancers. You may also find some of these organisations helpful:

  • Changing Faces supports people who have conditions or injuries that affect their appearance. It offers a skin camouflage service for people living with scarring or a skin condition that affects their confidence. Call 0300 012 0275 or email info@changingfaces.org.uk
  • Let’s Face It is a support network for people with facial disfigurements. Call 01843 833724 or 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. Call 07792357972 or email helpline@savingfaces.co.uk

A man is pressing his finger on his throat in a doctor's office.

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos


Radiotherapy for salivary gland cancer

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

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.

Planning your radiotherapy treatment

To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.

You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.

Having radiotherapy

Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.

The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.

Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Sore and sensitive skin

The skin over your face and neck will gradually redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.

When you wash your face and neck, it is very important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiography team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.

We have more information about skin care when you have radiotherapy to the head and neck area.

Sore mouth

It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean will help prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment – particularly the inside lining of your cheek. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.

We have more information about coping with a sore mouth.

Dry mouth

Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make your mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.

It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.

We have more information about coping with a dry mouth.

Thick, sticky saliva (mucus)

Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.

Rinsing your mouth regularly can help with this. Your specialist head and neck team can give you advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.

Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.

Difficulty eating

If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medications to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can buy some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.

Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.

Tiredness

This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.

Late effects of radiotherapy

Your doctor, specialist nurse or radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.

Our general information about head and neck cancers has more information about:

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for salivary gland cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is sometimes given 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.

Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.

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.

Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes 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:

  • feeling tired
  • a sore mouth
  • feeling sick (nausea) or being sick (vomiting)
  • hair loss.

Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.

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

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Clinical trials for salivary gland cancer

Cancer research trials are done 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 you fully understand the trial and what it means to take part. You can 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 after treatment

After your treatment finishes, you will have regular check-ups and tests. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.


Your feelings

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.

It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.

Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.

You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.

If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.

There are national support groups that you may find helpful:

  • Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
  • Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).

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