Salivary Glands

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed Feb 2017

The basics

Guidelines for treating this cancer have been developed by the Head & Neck Tumour Group.
For health professional information on treating this cancer, please see our Cancer Management Guidelines.
Salivary gland cancer may also be called parotid tumour, Warthin tumour, mucoepidermoid carcinoma, adenocarcinoma, and many other names.
Adenocarcinomas are tumours that start in gland cells. There are many different types of salivary gland adenocarcinomas.
There are three major pairs of salivary glands located in and around the mouth:

Parotid glands are the largest pair of glands and are located in the cheeks, in front of each ear
Submandibular (or submaxillary) glands lie just below the angle of the jaw bones, at the back of the mouth
Sublingual glands lie under the tongue

Many other minor salivary glands line the tissues of the mouth and throat.
Salivary glands produce saliva, or spit. Saliva enters the mouth through small openings called ducts. Saliva keeps the mouth and throat moist and helps with swallowing and digestion of food. Saliva also contains the minerals needed to maintain healthy teeth.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

Salivary gland cancer is rare and accounts for only 3% of all head & neck cancers.
Risk increases with age – cancers primarily occur in people over the age of 40.
The cause of most salivary gland tumours is unknown.
Exposure to ionizing radiation, including medical radiation treatments to the head, increases the risk of subsequent salivary gland cancer.
There is an association between smoking and Warthin tumour.
Workplace exposure to radioactive substances may increase risk.
There is weak evidence that workplace exposures to certain metals or mineral dusts (nickel alloys, silica) may increase the risk of developing salivary gland cancer.
There is weak evidence that a diet high in animal fats and low in vegetables may increase risk.
There is weak evidence that long-term cell phone use may be linked to an increase in parotid gland cancer rates.
Statistics

Can I help to prevent it?

Although specific causes for most salivary gland cancers are not certain, tobacco and excessive alcohol use are major risk factors for most other head and neck cancers. Limiting the use of alcohol and tobacco products may reduce the risk of getting salivary gland cancer.
To reduce your risk, don’t smoke, and avoid exposure to tobacco and cigarette smoke. Even if you have been using tobacco for many years, quitting will reduce your cancer risk. Support is available to help you successfully quit. Visit the BC Cancer Agency’s Prevention page on Tobacco for information and resources.
Avoid excessive use of alcohol. Not drinking at all will reduce your cancer risk the most. If you choose to drink alcohol, the key is to keep your drinking at the safest possible levels, called low-risk drinking. The American Institute for Cancer Research advises that if you do drink alcohol, limit your consumption to no more than two drinks a day for men and one drink a day for women.
Eating healthy, nutritious foods can reduce your cancer risk. Follow the recommendations in Canada's Food Guide and visit the BC Cancer Agency’s Prevention page on Nutrition for information and resources.
If you work with radioactive material, take precautions to protect yourself from exposure.

Screening for this cancer

No effective screening program exists for this cancer yet.

Regular medical and dental checkups will help ensure early diagnosis of salivary gland cancers.

Signs and symptoms

If any of the following symptoms last for more than two weeks, see a dentist or doctor.

A lump in the mouth, cheek, ear or jaw
Facial weakness or numbness
Pain in the face or mouth without obvious cause
Problems swallowing
Swelling of the face or neck

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Physical examination by a physician or dentist
Biopsy (usually a fine needle aspiration)
CT (computed tomography) scan may be needed

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and stages

Types

Most salivary gland tumours are benign (seldom life-threatening and not likely to spread).
Benign tumours may be present for years with very little change.
Specific types of benign tumours are:

Pleomorphic adenoma or mixed tumour, the most common salivary gland tumour, has a tendency to recur.
Warthin tumour, the second most common salivary gland tumour, usually occurs in the parotid glands.
Basal cell adenoma are rare and usually do not recur.

Mucoepidermoid carcinomas are the most common malignant tumour of the salivary glands.
Malignant tumours are classed as low grade (low risk) or high grade (high risk) according to cell type.
High grade tumours include:

Some mucoepidermoid carcinomas
Malignant mixed tumours are carcinomas that have arisen from a benign pleomorphic adenoma
Adenoid cystic carcinomas are the most common cancer of the minor salivary glands
Salivary duct carcinoma, which is one of the most aggressive salivary tumours, frequently recurs or spreads to distant sites (metastasis)
Oncocytic carcinoma also frequently recurs or spreads to distant sites
Large cell carcinomas are very rare, aggressive tumours

Low grade tumours include:

Most mucoepidermoid carcinomas
Acinic cell carcinomas, which usually start in the parotid glands
Clear cell carcinomas, which rarely spread beyond the salivary glands

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

T describes the site and size of the main tumour (primary)

N describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases)

Stage T0
No evidence of a primary tumour

Stage T1
Tumour is less than 2 cm

Stage T2
Tumour is larger than 2 cm but less than 4 cm

Stage T3
Tumour is larger than 4 cm across and/or is spreading into nearby soft tissues

Stage T4a
Tumour is any size and is growing into nearby structures such as the jaw bone, skin, ear canal, and/or facial nerve. (Moderately advanced disease.)

Stage T4b
Tumour is any size and is growing into nearby structures such as the base of the skull or other bones nearby, or it surrounds the carotid artery. (Very advanced disease.)

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

Surgery is the treatment of choice for both benign and malignant tumours.

Radiotherapy

External beam radiation therapy may be required after surgery for both benign and malignant tumours, to lower risk of recurrence.
Radiation therapy may be the main treatment if the tumour can not be completely removed, or for patients who are not able to undergo surgery.
Radiation therapy to the head and neck may affect the mouth and teeth. BC Cancer provides information to help reduce mouth problems during and following radiation therapy.

Chemotherapy

Chemotherapy may be used as a palliative therapy for patients with advanced cancer.

Follow-up after treatment

Guidelines for follow-up after treatment are covered on our website.
You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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