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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.
  • Eating a diet rich in fruits and vegetables may help prevent many cancers. The Canada Food Guide recommends eating 7-10 servings each day.
  • 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

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. The BC Cancer Agency 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 Agency 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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