Head & Neck Oncology Program

Salivary Gland Cancer

What Is Salivary Gland Cancer? | Symptoms and Diagnosis | Stages and Treatment | About Clinical Trials | Greenebaum Cancer Center

Stages and Treatments

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If the doctor finds cancer in the salivary gland, he or she will do more tests to find out whether the cancerous cells have spread beyond the salivary glands to other parts of the body. This process is called staging and is used to plan treatment.

The doctor will also determine the “grade” of the cancer – that is, whether the cancer cells are fast growing or slow growing – based on the appearance of the cells under a microscope. Knowing the grade of the tumor will help the doctor determine the best approach to treatment.

Stages of salivary gland cancers and typical treatments for each are described below:

Stage I: Stage I cancers in the salivary glands are no more than four centimeters (1.5 inches) in diameter and have not spread to the lymph nodes or to other nearby tissues. Surgery to remove the cancerous salivary gland is usually the first choice of treatment for low-grade (slow-growing) tumors. For high-grade (fast-growing) tumors, treatment may be one of the following:

Surgery
Surgery followed by radiation therapy
A clinical trial of new chemotherapy drugs

Stage II: At Stage II, a salivary gland tumor will have either of the following features:

It is no more than four centimeters across and has spread into the skin, soft tissue, bone, or nerve around the gland but not into the lymph nodes.
It is four to six centimeters (two inches) across and has not spread into other tissue or lymph nodes.

Low-grade Stage II cancers in the salivary gland are usually treated with surgery to remove the cancerous gland, possibly followed by radiation therapy, or chemotherapy if surgery and radiation are not effective or acceptable.

If the cancer is high grade, treatment options include:

surgery
surgery followed by radiation therapy
radiation therapy
a clinical trial of drugs that make cancer cells more sensitive to radiation
a clinical trial of chemotherapy

Stage III: At Stage III, cancer of the salivary gland is no more than four centimeters across. It has not spread to the skin, soft tissues, bone, or nerves, but it has spread to a single lymph node in the area.

Treatment of Stage III tumors in the salivary gland is usually either surgery, possibly followed by radiation, or chemotherapy (if surgery and radiation are not acceptable or effective).

Stage IV: Stage IV cancers include the following:

Tumors that are more than six centimeters in diameter and have spread into the skin, soft tissue, bone, or nerve around the gland. The cancer may or may not have spread to lymph nodes.
Cancers that are any size and have spread to lymph nodes on one or both sides of the neck or cancers that are more than six centimeters in diameter and have spread to any lymph node
Cancers that have spread to other parts of the body.

At Stage IV the most common treatments for salivary cancers are radiation therapy or a clinical trial of chemotherapy (with or without radiation therapy).

Recurrent: Recurrent cancer is cancer that has come back after being treated, either in the same location or in another part of the body. A patient with recurrent salivary gland cancer may be treated with radiation therapy or may participate in a clinical trial for new treatments for salivary gland cancer.

About the Treatments

Surgery
Surgery is probably the most common approach to treating cancer in the salivary glands. Depending on the location and stage of the tumor, a surgeon may be able to remove the tumor completely and may need to cut out some of the surrounding tissue. If the cancer has spread to lymph nodes in the neck, the lymph nodes may also need to be removed.

Radiation therapy
Radiation therapy is also commonly used to treat cancer of the salivary gland. Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). A special type of radiation therapy using tiny particles called neutrons has been shown to be effective in treating some salivary gland cancers. The use of drugs along with radiation therapy to make cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill or injected into a vein or muscle with a needle. It is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy for cancer of the salivary gland is still being tested in clinical trials.

Because the salivary glands help digest food and are close to the jaw, a patient may need special help adjusting to the side effects of the cancer and its treatment. Plastic surgery may be needed if a large amount of tissue or bone around the salivary glands is taken out.

This page was last updated on: May 14, 2009.