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NCI/PDQ^® Patients: Salivary Gland Cancer

National Cancer Institute
Ultima Vez Modificado: 31 de agosto del 2005

TABLE OF CONTENTS

• Description
  • What is cancer of the salivary gland?

• Stage Explanation
  • Stages of cancer of the salivary gland
  • Stage I
  • Stage II
  • Stage III
  • Stage IVA
  • Stage IVB
  • Stage IVC
  • Recurrent

• Treatment Option Overview
  • How cancer of the salivary gland is treated
  • Treatment by stage

• Stage I Salivary Gland Cancer

• Stage II Salivary Gland Cancer

• Stage III Salivary Gland Cancer

• Stage IV Salivary Gland Cancer

• Recurrent Salivary Gland Cancer

• Changes to This Summary (08/31/2005)

• To Learn More

• About PDQ®

Description

What is cancer of the salivary gland?

Cancer of the salivary gland is a disease in which cancer (malignant) cells are found in the tissues of the salivary glands. The salivary glands make saliva, the fluid that is released into the mouth to keep it moist and to help dissolve food.

Major clusters of salivary glands are found below the tongue, on the sides of the face just in front of the ears, and under the jawbone. Smaller clusters of salivary glands are found in other parts of the upper digestive tract. The smaller glands are called the minor salivary glands.

Many growths in the salivary glands do not spread to other tissues and are not cancer. These tumors are called benign tumors and are not usually treated the same as cancer.

A doctor should be seen if there is a swelling under the chin or around the jawbone, the face becomes numb, muscles in the face cannot move, or there is pain that does not go away in the face, chin, or neck.

If there are symptoms, a doctor will examine the throat and neck using a mirror and lights. The doctor may order a special x-ray called a computed tomographic or CT scan, which uses a computer to make a picture of the inside of parts of the body. Another type of scan, called a magnetic resonance imaging or MRI scan, uses magnetic waves to make a picture of the head may also be ordered. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the salivary glands, whether the cancer is just in the area where it started or has spread to other tissues (the stage), how the cancer cells look under a microscope (the grade), and the patient's general state of health.

Stage Explanation

Stages of cancer of the salivary gland

Once cancer of the salivary gland is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. Salivary gland cancers are also classified by grade, which tells how fast the cancer cells grow, based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

The following stages are used for cancer of the salivary gland:

Stage I

The cancer is 2 centimeters or less in diameter and has not spread outside the salivary glands.

Stage II

The cancer is larger than 2 centimeters but not larger than 4 centimeters in diameter and has not spread outside the salivary glands.

Stage III

Any of the following may be true:

• The cancer is larger than 4 centimeters in diameter and has spread into the skin, soft tissue, bone, or nerve around the gland. The cancer may have spread to a single lymph node.
• The cancer is less than 4 centimeters in size, and has spread to a single lymph node.

Stage IVA

Any of the following may be true:

• The cancer has spread into the skin, soft tissue, bone, or nerve around the salivary gland, may be as large as 6 centimeters, and may have spread to 1 or more lymph nodes, but has not spread to other parts of the body.
• The cancer is any size and has spread to nearby tissue and has spread to a single lymph node on the same side of the neck as the cancer, to lymph nodes on either side of the neck, or to any lymph node.

Stage IVB

Any of the following may be true:

• The cancer has spread into the bones of the skull and/or surrounded the carotid artery, the main (right and left) artery of the neck which carries blood to the head and brain, and may have spread to 1 or more lymph nodes.
• The cancer is greater than 6 centimeters and may have spread to nearby tissues, and has spread to at least 1 lymph node.

Stage IVC

The cancer may be of any size and may have spread to nearby tissues and lymph nodes, and has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the salivary gland or in another part of the body.

Treatment Option Overview

How cancer of the salivary gland is treated

There are treatments for all patients with cancer of the salivary gland. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
• Chemotherapy (using drugs to kill cancer cells).

Surgery is often used to remove cancers of the salivary gland. Depending on where the cancer is and how far it has spread, a doctor may need to cut out tissue around the cancer. If cancer has spread to lymph nodes in the neck, the lymph nodes may be removed (lymph node dissection).

Radiation therapy is also a common treatment of cancer of the salivary gland. Radiation therapy uses 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).

Specialized types of radiation have been shown to be effective in treating some salivary gland tumors. Fast-neutron beam radiation is a type of radiation therapy that uses tiny particles called neutrons. Photon-beam radiation therapy reaches deep tumors with high-energy light. Along with radiation therapy, the use of drugs to make cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy 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. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help in recovery from treatment. Plastic surgery may be needed if a large amount of tissue or bone around the salivary glands is taken out.

Treatment by stage

Treatment of cancer of the salivary gland depends on where the cancer is, the stage of the disease, and the patient's age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with cancer of the salivary gland. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Salivary Gland Cancer

Treatment depends on whether the cancer is low grade (slow growing) or high grade (fast growing).

If the cancer is low grade, treatment may be one of the following:

1. Surgery.
2. Surgery followed by radiation therapy.

If the cancer is high grade, treatment may be one of the following:

1. Surgery.
2. Surgery followed by radiation therapy.
3. A clinical trial of new chemotherapy drugs.

Stage II Salivary Gland Cancer

Treatment depends on whether the cancer is low grade (slow growing) or high grade (fast growing).

If the cancer is low grade, treatment may be one of the following:

1. Surgery possibly followed by radiation therapy.
2. Chemotherapy (if surgery or radiation is refused or if the cancer does not respond to surgery or radiation therapy).

If the cancer is high grade, treatment may be one of the following:

1. Surgery.
2. Surgery followed by radiation therapy.
3. Specialized radiation therapy.
4. A clinical trial of radiation therapy, with or without radiosensitization drugs (drugs given with radiation to make the cancer cells more sensitive to the radiation), or new chemotherapy drugs.

Stage III Salivary Gland Cancer

Treatment depends on whether the cancer is low grade (slow growing) or high grade (fast growing).

If the cancer is low grade, treatment may be one of the following:

1. Surgery possibly followed by radiation therapy.
2. Chemotherapy (if surgery or radiation therapy are refused or if the cancer does not respond to surgery or radiation therapy).
3. A clinical trial of specialized radiation therapy or new chemotherapy drugs.

If the cancer is high grade, treatment may be one of the following:

1. Surgery.
2. Surgery followed by radiation therapy.
3. Specialized radiation therapy.
4. A clinical trial of radiation therapy, with or without radiosensitization drugs (drugs given with radiation to make the cancer cells more sensitive to the radiation), or chemotherapy.

Stage IV Salivary Gland Cancer

Treatment may be one of the following:

1. Specialized radiation therapy.
2. A clinical trial of chemotherapy with or without radiation therapy.

Recurrent Salivary Gland Cancer

Treatment depends on the type of salivary gland cancer the patient has, where the cancer came back, the treatment the patient had before, and the patient's general health. Specialized radiation therapy may be given, or a patient may choose to take part in a clinical trial of new treatments.

Changes to This Summary (08/31/2005)

The PDQ® cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

To Learn More

Call

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The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

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The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

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• Suite 3036A
• 6116 Executive Boulevard, MSC8322
• Bethesda, MD 20892-8322

About PDQ®

PDQ® is a comprehensive cancer database available on NCI's Web site.

PDQ® is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ® is available online at NCI's Web site. PDQ® is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ® also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ® and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ®. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.