Salivary gland cancer affects the salivary glands in or near the mouth. Tumors that are malignant (cancerous) or benign (non-cancerous), occur in equal numbers.
The chance of treatment depends on where the cancer is located in the salivary glands, whether the cancer is in the area where it began or has spread to other tissues, how the cancer cells look under a microscope, and the patient's general health.
What are the salivary glands?
The salivary glands make and release saliva into the mouth to keep the mouth and throat moist, and to help swallow and digest food.
There are large and small salivary glands. There are three pairs of major salivary glands: the parotid, submandibular, and sublingual glands.
The parotid glands are found in front of the ears and behind the jaw. They transfer saliva to the mouth through a tube called the parotid duct. This tube opens from the inside of the cheek, near the upper molar. The nerve that controls the facial muscles (called the facial nerve), passes through the parotid gland. This nerve makes you smile, frown, close your eyes, and raise your eyebrows.
The parotid gland is the largest salivary gland where most salivary gland cancers occur.
The parotid glands also contain lymph nodes (bean-shaped glands that are part of the immune system's defense against infections). Skin cancers can sometimes spread to the lymph nodes within the parotid glands. Most parotid tumors are not cancers and are called benign tumors.
Submandibular and sublingual glands
The submandibular glands are located under the jawbone, one on each side. They release saliva into the mouth through a duct (tube) that opens at the floor of the mouth, under the tip of the tongue. Three important nerves are found beside these glands – the hypoglossal nerve, the lingual nerve, and the marginal branch of the facial nerve. These nerves give movement, feeling and taste to the tongue and move the lower lip. Submandibular gland tumors can be benign (not cancerous) or malignant (cancerous).
The sublingual glands are located under the tongue, one on each side. They release saliva into the submandibular canal and are located near the lingual nerves that give feeling and taste at the front of the tongue. The sublingual glands are the smallest of the major salivary glands and rarely develop tumors, but they tend to be malignant (cancer) when they do develop.
minor salivary glands
There are hundreds of small salivary glands scattered in the mouth and throat. They can be found inside the mouth, just below the surface including the lips, cheeks, and top of the mouth (soft palate). Small salivary glands can also develop tumors that can be benign or malignant.
Diagram of the salivary glands and their surroundings:
What is salivary gland cancer?
Salivary gland cancer is a term used to describe malignant tumors of the salivary glands in or near the mouth. Salivary gland tumors may be benign (noncancerous) or malignant (cancerous), each of which occurs with equal frequency.
Salivary gland cancer may affect any of the salivary glands. Your prognosis (outlook) depends on the type of salivary gland cancer you have and the stage of the disease (how advanced the disease is).
Who is likely to get salivary gland cancer?
- Anyone can develop salivary gland cancer, but men are more likely to develop salivary gland tumors. You are also more likely to get salivary gland cancer if you are: Age 55 or older
- You smoke or abuse alcohol frequently
- Receive radiation therapy to your head or neck or are exposed to radioactive materials
- She works in some occupations, including plumbing, rubber product manufacturing, asbestos mining, and the leather industries
Symptoms and causes
What causes salivary gland cancer?
The exact cause of most salivary gland cancers is unknown. Salivary gland tumors can occur in any salivary gland located in or near the mouth. Most commonly, tumors occur in the three major salivary glands. These include:
- Parotid glands (inside each cheek)
- Submandibular glands (at the bottom of the mouth)
- glands under the tongue (under the tongue)
Salivary gland carcinoma also occurs within the microscopically small salivary glands. These glands are located within the roof or floor of the mouth, the lining of the tongue and lips, and inside the cheeks, sinuses, nose, and voice box. Salivary gland tumors may be benign or malignant (cancer). Benign tumors generally grow slowly and are not likely to spread to other tissues. About 50 percent of salivary gland tumors are noncancerous. However, some salivary gland tumors are malignant and may spread to other areas of the body.
What are the symptoms of salivary gland cancer?
A small number of people with salivary gland cancer have no symptoms. In most cases, salivary gland cancer causes a painless mass in the salivary glands.
If your salivary gland tumor is malignant, you're more likely to have other symptoms, including:
- Weakness or numbness in the face, neck, jaw, or mouth.
- Persistent pain in the face, neck, jaw, or mouth.
- Difficulty opening your mouth fully or moving your facial muscles.
- difficulty swallowing;
- bleeding from the mouth;
Diagnostics and tests
How is salivary gland cancer diagnosed?
Your doctor diagnoses salivary gland cancer through a physical exam and a review of your medical and personal history. In some cases, doctors order additional diagnostic tests to confirm the presence of a tumor. These tests may include:
- Computerized tomography using X-rays to provide images of masses within the salivary glands
- Magnetic resonance imaging (MRI), which uses magnets and radio waves to create images of internal body structures
- Positron emission tomography (PET) scan using small amounts of radioactive material to identify cancerous masses
- Fine needle biopsy to collect a small sample of tissue and fluid from a salivary gland tumor for further examination in the laboratory
When should I call my doctor?
If you have any of the symptoms of a salivary gland tumor listed above, especially if symptoms persist for more than two weeks, call your doctor for a diagnostic evaluation.
What are the stages of salivary gland cancer?
Once salivary gland cancer is detected, further tests will be done to see if the cancer cells have spread to other parts of the body. This is called staging. The doctor needs to know the stage of the disease to plan treatment. Salivary gland cancers are also classified by "grade," which tells us how fast the cancer cells are growing, based on how the cells look under the microscope. Low-grade cancers grow more slowly than high-grade cancers.
The following stages are used to treat salivary gland cancer:
Stage I salivary gland cancer
The cancer is 2 cm or less in diameter and has not spread beyond the salivary glands.
stage 2 salivary gland cancer
The cancer is larger than 2 cm, but not more than 4 cm in diameter and has not spread beyond the salivary glands.
stage III salivary gland cancer
- Any of the following may be true: Cancer is more than 4 cm in diameter and has spread to the skin, soft tissue, bone, or nerves around the gland. The cancer may have spread to a single lymph node.
- Cancer is less than 4 cm in size and has spread to one lymph node.
stage IV salivary gland cancer
The first fourth stage
Any of the following may be true:
- Cancer has spread to the skin, soft tissue, bone, or nerves around the salivary gland, may be up to 6 centimeters in size, and may have spread to one or more lymph nodes, but has not spread to other parts of the body.
- Cancer is any size and has spread to nearby tissues and has spread to a single lymph node on the same side of the neck as the cancer, to lymph nodes on both sides of the neck, or to any lymph node.
The second fourth stage
Any of the following may be true:
- Cancer has spread to the bones of the skull and/or the surrounding carotid artery, which is the main artery (right and left) of the neck that carries blood to the head and brain, and may have spread to one or more lymph nodes.
- Cancer is larger than 6 cm and may have spread to nearby tissues and has spread to at least one lymph node.
The third fourth stage
Cancer may be of any size and may have spread to nearby tissues and lymph nodes, and to other parts of the body.
salivary gland cancer recurrence
Recurrent disease means the cancer has come back (recurred) after it has been treated. It may return in the salivary glands or in another part of the body.
Management and treatment
How is salivary gland cancer treated?
Surgery is the main treatment option for benign salivary gland tumors. After surgery, your recovery focuses on preventing infection and managing pain. Your doctor may prescribe medications such as antibiotics and pain relievers to achieve these goals.
For malignant salivary gland cancers, doctors perform surgery to remove the tumor. After surgery, you'll likely receive radiation therapy to the cancerous area and bleeding lymph nodes. Radiation helps kill all the cancer cells so that the cancer doesn't come back.
In some cases, doctors recommend chemotherapy if the cancer has spread from the salivary glands to other tissues outside the head and neck.