Salivary Gland Cancer

The cause of most salivary gland cancers is not known.

Salivary gland cancer may not cause any symptoms. It may be found during a regular dental check-up or physical exam. Signs and symptoms may be caused by salivary gland cancer or by other conditions. Check with your doctor if you have any of the following:

• A lump (usually painless) in the area of the cheek, upper neck, or mouth area
• Trouble swallowing or opening the mouth widely
• Numbness or weakness in the face
• Pain in the face that does not go away

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity--such as smoking or diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

• Older age
• Treatment with radiation therapy to the head and neck
• Being exposed to certain substances at work

In addition to a complete medical history and physical examination, diagnostic procedures for salivary gland cancer may include one or more of the following:

• Computed tomography (CT-scan). A noninvasive procedure that takes horizontal, or axial, images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary X-ray.
• Ultrasonography. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs.
• Magnetic resonance imaging (MRI). strong>A noninvasive procedure that produces 2-dimensional view of an internal organ or structure, especially the brain and spinal cord. If additional imaging is needed, your doctor may order a PET scan, which can determine where your cancer started.
• PET scan (positron emission tomography scan). A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes 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.
• Endoscopy. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. An endoscopy procedure is used to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the nose to look at the nose, throat, and larynx. The scope can also be used to obtain biopsies.
• Biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
  • Fine needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle. An FNA is the most common type of biopsy used for salivary gland cancer.
  • Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn’t look normal.
  • Surgery: If cancer cannot be diagnosed from the sample of tissue removed during an FNA biopsy or an incisional biopsy, the mass may be removed and checked for signs of cancer.

Because salivary gland cancer can be hard to diagnose, patients should ask to have the tissue samples checked by a pathologist who has experience in diagnosing salivary gland cancer. Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.

Patients with salivary gland cancer should have their treatment planned by a team of surgeons and medical doctors who are experts in treating salivary gland cancer such as the specialists at Dana-Farber Brigham Cancer Center (DFBCC), an exceptional collaboration between two world-class medical centers. The DFBCC is composed of BWH surgical oncologists and medical oncologists, radiation oncologists and other specialists at Dana-Farber Cancer Institute.

Because the salivary glands help in eating and digesting food, patients may need special help adjusting to the side effects of the cancer and its treatment. You may be referred to other healthcare specialists who have experience and expertise in treating patients with salivary gland cancer and who specialize in certain areas of health care. These include the following:

• Dentist
• Speech therapist
• Dietitian
• Psychologist
• Rehabilitation specialist

Treatment may include:

• Surgery. A surgeon may remove the cancer and some of the healthy tissue around the cancer. Adjacent lymph nodes may also be removed with surgery.
  • Primary tumor resection. Removal of the entire tumor and surrounding area of tissue
  • Transoral Robotic Surgery (TORS), a minimally invasive procedure which improves outcomes and avoids complications may be used for minor salivary gland cancers in the pharynx or throat.
• Radiation therapy. Treatment that uses high-energy rays that kill cancer cells and halts the spread of cancer. Radiation therapy is very localized, aimed at the cancer area. Radiation therapy may be administered externally with a machine, or internally with radioactive materials.
• Chemotherapy. Medications that go throughout the entire body to kill cancer cells. Chemotherapy has the ability to interfere with the cancer cell's replication. Chemotherapy may be used in combination with surgery and radiation therapy.
• Targeted therapy. Drugs that target specific cancer cells and immune mechanisms are also an option and often cause fewer side effects than chemotherapy that kills both cancerous and noncancerous cells.

A Brigham and Women’s Hospital otolaryngologist will begin with a complete evaluation and assessment of your specific condition. As part of the assessment, we will establish which treatment is indicated. A customized treatment plan will be established and you will work with the appropriate services.

Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

If surgery is needed, you will be taken care of in the operating room by an experienced otolaryngology surgeon. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.

Brigham and Women’s Faulkner Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to Brigham and Women's Hospital's world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our otolaryngologists are faculty members at Harvard Medical School and active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the ear, nose and throat.