A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Salivary Gland Cancer

Our Approach
City of Hope offers a truly comprehensive approach to salivary gland cancer. We employ the latest chemotherapy protocols and develop promising experimental therapies through our drug development research programs. These combined attributes allow us to provide powerful therapeutic options to patients fighting salivary gland cancer.

Salivary gland cancer patients at City of Hope receive treatment from a coordinated, multidisciplinary team of surgeons, oncologists, endocrinologists, radiation oncologists, nurses, supportive care specialists and others, ensuring the highest possible standard of care.

Salivary Gland Cancer Staging

Staging is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and predicting your chance for cure and long-term survival.

Staging is based on the results of the physical exam, biopsy, the physician’s impression during or after surgery to remove the tumor (presence or absence of invasion of the tumor to other organs) and imaging tests (ultrasound, computed tomography scan, magnetic resonance imaging, positron emission tomography scan or endoscopy).

Stage I
In stage I, the tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II
In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III
In stage III, one of the following is true:

The tumor is not larger than 4 centimeters and has spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

The tumor is larger than 4 centimeters and/or has spread to soft tissue around the affected gland. Cancer may have spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV
Stage IV is divided into stages IVA, IVB and IVC as follows:

Stage IVA:
The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to one or more lymph nodes on either or both sides of the body and the lymph nodes are not larger than 6 centimeters; or

Cancer has spread to the skin, jawbone, ear canal and/or facial nerve, and may have spread to one or more lymph nodes on either or both sides of the body. The lymph nodes are not larger than 6 centimeters.

Stage IVB:
The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to a lymph node larger than 6 centimeters; or

Cancer has spread to the base of the skull and/or the carotid artery, and may have spread to one or more lymph nodes of any size on either or both sides of the body.

Stage IVC:
The tumor may be any size and may have spread to soft tissue around the affected gland, to the skin, jawbone, ear canal, facial nerve, base of the skull or carotid artery, or to one or more lymph nodes on either or both sides of the body. Cancer has spread to distant parts of the body.

Salivary gland cancers are also grouped by grade. The grade of a tumor describes how fast the cancer cells are growing based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

Minor salivary gland cancers are staged according to where they were first found in the body.

Salivary Gland Cancer Risk Factors

  • Age: Most patients are diagnosed in their 50s and 60s
  • External radiation exposure, especially to the head and neck; this includes radiation therapy used in previous cancer treatment
  • Tobacco use – both smoking and chewing tobacco may increase the risk of squamous cell salivary cancers
  • Occupational exposure – workers exposed to silica dust, nickel-containing dust, asbestos, as well as those engaged in rubber products manufacturing, plumbing and some types of woodworking may be more likely to develop salivary cancer
  • Family history of salivary gland cancer
  • Diet – some studies suggest a diet high in animal fats and low in vegetables may increase the risk of salivary gland cancer

Salivary Gland Cancer Symptoms

Salivary gland cancer may not cause any symptoms. It is sometimes found during a regular dental check-up or physical exam. Symptoms caused by salivary gland cancer also may be caused by other conditions.
 
Symptoms specific or more common to a particular type of salivary gland cancer are mentioned in the descriptions of each type of cancer, listed above. A doctor should be consulted if any of the following problems occur:
 
  • A lump (usually painless) in the area of the ear, cheek, jaw, lip or inside the mouth
  • Fluid draining from the ear
  • Trouble swallowing or opening the mouth widely
  • Numbness or weakness in the face
  • Pain in the face that does not go away

Diagnosing Salivary Gland Cancer

A variety of methods is used to diagnose salivary gland cancer. They include:
 

  • Physical exam and history
After a physical exam that reveals cause for suspicion of salivary gland cancer, imaging tests may be ordered to determine the extent of spread of the tumor, if any. Standard imaging tests include:
 

 

  • Magnetic resonance imaging (MRI): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear MRI , or NMRI.
  • CT (computed tomography) scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computerized tomography or computerized axial tomography.
  • Positron emission tomography (PET) scan: A procedure to find malignant tumor cells in the body. A small amount of a radioactive glucose derivative (fluorodeoxyglucose) is injected into a vein. The PET scanner rotates around the body and generates a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.


After identifying the primary site or sites of the tumor, a biopsy may be ordered, as detailed below:
 

  • Fine needle aspiration biopsy: The removal of tissue or fluid using a thin needle. A pathologist views the tissue or fluid under a microscope to look for cancer cells. This test is necessary to establish three things: 1) whether the tumor is benign or malignant, 2) what type of cell the tumor originated from and 3) what grade, or level of differentiation, the tumor cells display.
 

Salivary Gland Cancer Treatment Options

Department of Surgery
First-line treatment for salivary gland cancer is surgery.  The surgeon will remove the affected salivary gland and possibly some surrounding tissue.  If nearby lymph nodes are thought to be involved, they will also be removed, and a neck dissection will be performed.
 
Radiation Therapy
In cases of higher-grade or larger tumors, unclean surgical margins or evidence of lymph node metastasis, postoperative radiation therapy is recommended to improve clinical outcomes. It may be used by itself in cases where the tumor may be too large to be removed surgically, where surgery would be disfiguring, or if the tumor is inoperable for other reasons. It is useful for reducing symptoms such as pain and difficulty in swallowing.
 
City of Hope’s Radiation Oncology was the first in the western United States to offer the helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
 
Radiation therapy is a localized treatment, which means it provides benefits — and side effects — in the exact area where it’s delivered.  By reducing the radiation dose to an area of normal, healthy tissue, a patient will experience potentially fewer side effects than they would in a more conventional treatment setting. This is especially important in the treatment of cancers of the head and neck region.  If the radiation dose can be spared to any portion of the oral cavity (mouth) or throat, the patient will experience significant fewer problems in making their way through the course of treatment. This advanced technique makes it possible to reduce the dose to the parotid gland, hence – saliva is preserved – lessening a patient’s possibility of having a dry mouth.  In addition, TomoTherapy can assist in reducing dose to the normal swallowing muscles.  This can improve a patient’s ability to continue eating – directly impacting a patient’s quality of life.
 
Chemotherapy
Chemotherapy is sometimes used with radiation in cases of salivary gland cancer where the disease is metastatic, unresectable and/or recurrent.  It may also be employed postsurgically (along with radiation) in late-stage or aggressive cancers. Chemotherapy regimens vary depending on the particular cell type in question.
 
Clinical Trials
City of Hope has several clinical trials involving experimental therapies for advanced solid tumors of the head and neck. Some of these may apply to salivary cancer.  One clinical trial includes the use of cetuximab (Erbitux), a monoclonal antibody that inhibits EGFR (epidermal growth factor receptor), impairing the growth of cancer cells. Sometimes, this is combined with radiation and chemotherapy.  Click here for more information.
 
Follow-up
Because salivary gland cancer can recur, patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include thorough head and neck palpation as well as multiple imaging modalities, e.g., ultrasound, CT, magnetic resonance imaging and positron emission tomography scans.
 

Salivary Gland Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
Our Programs and Treatments

City of Hope is a national leader in cancer treatment and prevention. Read more...

City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the Schedule a Callback form.
Our treatment facilities are located throughout our 100+ acre grounds in Duarte, California as well as in  Antelope Valley, South Pasadena, Santa Clarita and Palm Springs.
Led by multidisciplinary teams of volunteers and professionals, the Sheri & Les Biller Patient and Family Resource Center offers an integrated array of cancer support services.
City of Hope combines compassionate care with the best and most innovative science. Our 100+ acre campus is designed to meet the full range of needs of our patients and families. This guide is designed to help you take advantage of all that is offered at City of Hope.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
NEWS & UPDATES
  • Cancer cells may be known for their uncontrollable growth and spread, but they also differ from normal tissue in another manner: how they produce energy. In healthy cells, energy is derived primarily from aerobic respiration, an oxygen-requiring process that extracts the maximum possible energy from glucose, or...
  • Clinical trials are expensive and complex, but they’re essential for bringing new therapies to patients. Edward Newman, Ph.D., associate professor of molecular pharmacology, just boosted City of Hope’s ability to conduct those studies with a five-year, $4.2 million grant from the National Cancer Institute...
  • Meet City of Hope’s new chair of the Department of Surgery – esteemed pancreatic and hepatobiliary surgeon, researcher and author Yuman Fong, M.D. As one of today’s most respected and recognizable physicians in the treatment of cancers of the liver, bile duct, gallbladder and pancreas, Fong has pioneered and en...
  • For most of her life, Southern California teenager Kayla Saikaly described herself as healthy, even very healthy. She played basketball. She never missed school with as much as a fever. Her worst childhood illness was nothing more than a cold. Then, when she was 13, her nose started bleeding after a basketball ...
  • Neuroblastoma is one of the deadliest childhood cancers, accounting for 15 percent of pediatric cancer deaths. For patients with high-risk neuroblastomas, the five-year survival rate is 40 to 50 percent even with the most rigorous treatments available today. But those odds may improve soon, thanks to a new comp...
  • For breast cancer survivors, a common worry is a recurrence of their cancer. Currently, these patients are screened with regular mammograms, but there’s no way to tell who is more likely to have a recurrence and who is fully cleared of her cancer. A new blood test – reported in Cancer Research, a journal of the...
  • Metastasis — the spreading of cancer cells from a primary tumor site to other parts of the body — generally leads to poorer outcomes for patients, so oncologists and researchers are constantly seeking new ways to detect and thwart this malicious process. Now City of Hope researchers may have identified a substa...
  • Deodorant, plastic bottles, grilled foods, artificial sweeteners, soy products … Do any of these products really cause cancer? With so many cancer myths and urban legends out there, why not ask the experts? They can debunk cancer myths while sharing cancer facts that matter, such as risk factors, preventi...
  • Cancer risk varies by ethnicity, as does the risk of cancer-related death. But the size of those differences can be surprising, highlighting the health disparities that exist among various ethnic groups in the United States. Both cancer incidence and death rates for men are highest among African-Americans, acco...
  • George Winston, known worldwide for his impressionistic, genre-defying music, considers music to be his first language, and admits he often stumbles over words – especially when he attempts languages other than English. There’s one German phrase he’s determined to perfect, however: danke schön. Winston thinks h...
  • Few decisions are more important than those involving health care, and few decisions can have such lasting impact, not only on oneself but on relatives and loved ones. Those choices, especially, should be made in advance – carefully, deliberately, free of pain and stress, and with much weighing of values and pr...
  • Using a card game to make decisions about health care, especially as those decisions relate to the end of life, would seem to be a poor idea. It isn’t. The GoWish Game makes those overwhelming, but all-important decisions not just easy, but natural. On each card of the 36-card deck is listed what seriously ill,...
  • Young adults and adolescents with cancer face unique challenges both during their treatment and afterward. Not only are therapies for children and older adults not always appropriate for them, they also must come to terms with the disease and treatment’s impact on their relationships, finances, school or ...
  • Breast cancer is the most common cancer, other than skin cancer, among women in the United States. It’s also the second-leading cause of cancer death, behind lung cancer. In the past several years, various task force recommendations and studies have questioned the benefits of broad screening guidelines fo...
  • Paternal age and the health effects it has on potential offspring have been the focus of many studies, but few have examined the effect parental age has on the risk of adult-onset hormone-related cancers (breast cancer, ovarian cancer and endometrial cancer). A team of City of Hope researchers, lead by Yani Lu,...