Salivary gland cancers are not very common, making up less than 1% of cancers in the United States. They occur at a rate of about 1 case per 100,000 people per year in the United States.

These cancers can occur in people of almost any age, but they become more common as people get older. The average age at the time of diagnosis is 64.

Overall, about 72% of people diagnosed with salivary gland cancer are still alive at least 5 years after being diagnosed. (This includes people with all types and stages of salivary gland cancer, but the outlook for some people might be better or worse than this.) For more statistics related to survival, see Survival Rates for Salivary Gland Cancer by Stage.

Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). 

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured). To get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a better outlook for people now being diagnosed with salivary gland cancer.

5-year relative survival rates (such as the numbers below) assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to describe the prognosis for patients with a particular type and stage of cancer.

The rates below are based on the stage of the cancer at the time of diagnosis. When looking at survival rates, it’s important to understand that the stage of a cancer does not change over time, even if the cancer progresses. A cancer that spreads or comes back is still referred to by the stage it was given when it was first found, but more information is added to explain the current extent of the cancer. (And of course, the treatment plan is adjusted based on the change in cancer status.)

The numbers below come from the National Cancer Database, and are based on people diagnosed with cancer of the major salivary glands between 1998 and 1999.

Again, these numbers include people who were diagnosed and treated many years ago, so the outlook for people now being diagnosed might be better.

Survival rates are based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any person’s case. The stage of the cancer is important, but many other factors can also affect a person’s outlook, such as their age, the type and grade of the cancer, and how well the cancer responds to treatment. Even when taking these factors into account, survival rates are at best rough estimates. Your doctor is familiar with the aspects of your particular situation and can tell you how the numbers above might apply to you.

Salivary gland cancer is most often diagnosed when a person goes to a doctor because of symptoms he or she is having.

If you have signs or symptoms that might be caused by a salivary gland tumor, your doctor will do exams and tests to find out if it’s cancer or some other condition. If cancer is found, more tests may be done to find out if it has spread.

Medical history and physical exam

Usually the first step is to take your medical history. The doctor will ask about your symptoms and when they first appeared. You might also be asked about possible risk factors for salivary gland cancer and about your general health.

During the physical exam, your doctor will carefully examine your mouth and the areas on the sides of your face and around your ears and jaw. The doctor will feel for enlarged lymph nodes (lumps under the skin) in your neck, since these could be signs of cancer spread.

The doctor will also check for numbness or weakness in your face (which can happen when cancer spreads into nerves).

If the results of this exam are abnormal, your doctor may order imaging tests or refer you to an ear, nose, and throat (ENT) doctor, also known as an otolaryngologist, who will do a more thorough exam of the head and neck area.

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive particles to create pictures of the inside of your body. Imaging tests may be done for a number of reasons, including to help find a suspicious area that might be cancer, to learn how far cancer may have spread, and to help find out if treatment has been effective.

X-rays

If you have a lump or swelling near your jaw, your doctor may order x-rays of your jaws and teeth to look for a tumor.

If you've been diagnosed with cancer, an x-ray of your chest may be done to see if the cancer has spread to your lungs. This also provides other information about your heart and lungs that might be useful if surgery is planned.

Computed tomography (CT or CAT) scan

A CT scan uses x-rays to produce detailed cross-sectional images of your body. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). A CT scan can show the size, shape, and position of a tumor and can help find enlarged lymph nodes that might contain cancer. If needed, CT scans can also be used to look for tumors in other parts of the body.

Before the scan, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the structures in your head and neck so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures in your body.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans make detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into very detailed images of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details.

MRI scans can help determine the exact location and extent of a tumor. They can also show any lymph nodes that are enlarged or if other organs have suspicious spots, which might be due to the spread of cancer.

Positron emission tomography (PET) scan

A PET scan looks for areas of high cellular activity (which might be a sign of cancer), rather than just showing if areas look abnormal based on their size or shape. This test can help show whether an abnormal lump or tumor seen on another imaging test may be cancer. If you have been diagnosed with cancer, your doctor may use this test to see if the cancer has spread to lymph nodes or other parts of the body. A PET scan can also be useful if your doctor thinks the cancer might have spread but doesn’t know where.

Biopsy

Symptoms and the results of exams or imaging tests may strongly suggest you have salivary gland cancer, but the actual diagnosis is made by removing cells from an abnormal area and looking at them under a microscope. This is known as a biopsy. Different types of biopsies might be done, depending on the situation.

Fine needle aspiration (FNA) biopsy

An FNA biopsy is used to remove a small amount of cells and fluid from a lump or tumor for testing. This type of biopsy can be done in a doctor’s office or clinic. It’s done with a thin, hollow needle much like those used for routine blood tests.

Your doctor may first numb the area over the tumor. The doctor then puts the needle right into the tumor and pulls cells and a few drops of fluid into a syringe. The sample is then sent to a lab, where it’s checked under a microscope to look for cancer cells.

Doctors may use FNA if they are not sure whether a lump is a salivary gland cancer. The FNA might show the lump is due to an infection, a benign (non-cancerous) salivary tumor, or a salivary gland cancer. In some cases this type of biopsy can help a person avoid unnecessary surgery.

An FNA biopsy is only helpful if enough cells are taken out to be able to tell for certain what a tumor is made of. But sometimes not enough cells are removed, or the biopsy is read as negative (normal) even when the tumor is cancer. If the doctor is not sure about the FNA results, a different type of biopsy might be needed.

Incisional biopsy

This type of biopsy may sometimes be done if the FNA biopsy didn't get a large enough sample. In this procedure, the surgeon numbs the area over the tumor, makes a small incision (cut) with a scalpel and takes out a tiny part of the tumor. The specimen is sent to the lab to be looked at by the pathologist. These types of biopsies are not done often for salivary gland tumors.

Surgery

As mentioned above, FNA biopsy of a suspected salivary gland cancer may not always provide a clear answer. If this is the case but the physical exam and imaging tests suggest that it is cancer, the doctor may advise surgery to remove the tumor completely. This can both provide enough of a sample for a diagnosis and treat the tumor at the same time (see Surgery for Salivary Gland Cancer for more information).

In some cases if the exams and tests suggest cancer is likely, the doctor may skip the FNA biopsy altogether and go directly to surgery to remove the tumor. The specimen is then sent to the lab to confirm the diagnosis.

The treatment options for salivary gland cancer depend largely on the stage (extent) of the cancer. But other factors, such as the grade of the cancer (how likely it is to grow and spread quickly); and a person’s overall health, can also be important.

Stage I

These cancers are small and still within the salivary gland. If you have stage I salivary gland cancer, your doctors will probably recommend surgery to remove the cancer and part or all of the salivary gland.

Radiation therapy may be advised after surgery if you have an intermediate- or high-grade cancer or an adenoid cystic carcinoma, if the cancer could not be removed completely, or if the edges of the removed area contain cancer cells (a sign that some cancer may have been left behind).

Stage II

Stage II salivary gland cancers are larger but are still confined within the salivary gland. They are also treated mainly with surgery, but it may be more extensive (covering a wider area) than for stage I cancers. The surgeon may also remove lymph nodes in your neck on the same side to see if they contain cancer.

Radiation therapy  may be given after surgery if your cancer is intermediate- or high-grade or an adenoid cystic carcinoma, if the cancer could not be removed completely, or if the edges of the removed specimen contain cancer cells. There is a greater chance that some cancer may have been left behind than with stage I cancers.

Radiation therapy might be an option as the main treatment if surgery would result in serious problems with eating, speech, or appearance, or for people who refuse surgery. But it’s not clear if this offers the same chance to cure the cancer as surgery, so not all doctors agree that this is a good approach for stage II cancers.

Stage III

These cancers are even larger and/or have started to grow outside the salivary gland. They might have also reached lymph nodes in the neck.

Doctors generally recommend extensive surgery (removing the salivary gland containing the tumor, nearby tissues, and all lymph nodes in your neck on the same side) if it’s possible. For low-grade tumors with no concerning features, this might be the only treatment needed if all of the cancer is removed. But in many cases, especially for high-grade tumors, surgery is followed by radiation therapy. Chemotherapy (chemo) may be added as well, but it’s not clear how helpful this is. This is still being studied.

Radiation therapy (with or without chemo) may be used as the main treatment if surgery is not a good option (for example, if surgical removal of the cancer would cause serious problems with eating, speech, or appearance).

Stage IV

Stage IV salivary gland cancers are very hard to cure, particularly if the cancer has spread to distant organs.

Some of these cancers might be treated with surgery if the doctor feels all of the cancer can be removed. (This would be followed by radiation therapy and maybe chemo.)

But most often, radiation therapy is used as the main treatment. It's used to try to shrink the tumor(s) and relieve pain, bleeding, or other symptoms. Radiation may be combined with chemo. If the cancer has spread to other parts of the body, chemo may shrink or slow the growth of the cancer for a time and may help relieve symptoms.

Because these cancers can be hard to treat, taking part in a clinical trial of newer treatments is a good option.

The major salivary glands are on each side of the face and below the tongue. Several important nerves and other structures run through or near salivary glands and can be affected by salivary tumors.

Possible signs and symptoms of salivary gland cancer include:

• A lump or swelling in your mouth, cheek, jaw, or neck
• Pain in your mouth, cheek, jaw, ear, or neck that does not go away
• A difference between the size and/or shape of the left and right sides of your face or neck
• Numbness in part of your face
• Weakness of the muscles on one side of your face
• Trouble opening your mouth widely
• Fluid draining from an ear
• Trouble swallowing

Many of these signs and symptoms can also be caused by benign (non-cancerous) salivary gland tumors or by other conditions. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Surgery is often the main treatment for salivary gland cancers. Your cancer will probably be treated with surgery if the doctor believes that he or she can remove it completely. (That is, if the cancer is resectable.) Whether or not a cancer is resectable depends largely on how far it has grown into nearby structures, but it also depends on the skill and experience of the surgeon. Being treated by a surgeon who has treated many patients with salivary gland cancer gives you the best chance of having your cancer removed completely. This, in turn, gives you the best chance of being cured.

In most cases, the cancer and some or all of the surrounding salivary gland will be removed. Nearby soft tissue may be taken out too. The goal is to have no cancer cells in the outside edges (margin) of the removed tumor. If the cancer is high grade (more likely to grow and spread quickly) or if it has already spread to lymph nodes, t lymph nodes from the same side of the neck may be removed in an operation called a neck dissection (described below).

Before surgery, ask your surgeon exactly what will be done during the operation, what the goals of the surgery are, whether there are other options, whether surgery will change the way you look or the way your body works, and what side effects you can expect.

Types of surgery for salivary gland cancer

The type of surgery will depend on which salivary gland is affected.

Parotid gland surgery

Most salivary gland tumors occur in the parotid gland. Surgery here is complicated by the fact that the facial nerve, which controls movement on the same side of the face, passes through the gland. For these operations, an incision (cut) is made in the skin in front of the ear and may extend down to the neck.

Most parotid gland cancers start in the outside part of the gland, called the superficial lobe. These can be treated by removing only this lobe, which is called a superficial parotidectomy. This usually leaves the facial nerve intact and does not affect facial movement.

If your cancer has spread into deeper tissues, the surgeon will remove the entire gland. This operation is called a total parotidectomy. If the cancer has grown into the facial nerve, it will have to be removed as well. If your surgeon has mentioned this surgery as a possibility, ask what can be done to repair the nerve and ways to treat side effects caused by removing the nerve. If the cancer has grown into other tissues near your parotid gland, these tissues might also need to be removed.

Submandibular or sublingual gland surgery

If your cancer is in the submandibular or sublingual glands, the surgeon will make a cut in the skin to remove the entire gland and perhaps some of the surrounding tissue or bone. Nerves that pass through or near these glands control movement of the tongue and the lower half of the face, as well as sensation and taste. Depending on the size and location of the cancer, the surgeon may need to remove some of these nerves.

Minor salivary gland surgery

Minor salivary gland cancers can occur in your lips, tongue, palate (roof of the mouth), mouth, throat, voice box (larynx), nose, and sinuses. The surgeon usually removes some surrounding tissue along with the cancer. The exact details of surgery depend on the size and location of the cancer.

Possible risks and side effects of salivary gland surgery

All surgery has some risks, including complications from anesthesia, bleeding, blood clots, and infections. These risks are generally low but are higher with more complicated operations.

For any salivary gland cancer surgery, the surgeon may need to cut through your skin or cut inside your mouth. Most people will have some pain afterwards , but this can usually be controlled with medicines.

If your facial nerve is damaged during surgery, you might lose control of your facial muscles on the side where the surgery was done. That side of your face may droop. If the injury to the facial nerve is related to retraction (pulling) of the nerve during surgery and/or swelling from the operation, the damage might heal over time.

Sometimes, nerves cut during surgery grow back abnormally and become connected to the sweat glands of the face. This condition, called Frey syndrome or gustatory sweating, results in flushing or sweating over areas of your face when you chew. Frey syndrome can be treated with medicines or with additional surgery.

Damage to other nerves in the face or mouth might cause problems with tongue movement, speech, or swallowing.

Depending on the extent of the operation, your appearance may be changed as a result of surgery. This can range from a simple scar on the side of the face or neck to more extensive changes if nerves, parts of bones, or other structures need to be removed.

It’s important to talk with your doctor before the surgery about what changes in appearance or other side effects you might expect. This can help you prepare for them. Your doctor can also give you an idea about what corrective options might be available afterward, such as skin grafts, nerve grafts, and reconstructive surgery.

Lymph node removal (neck dissection)

Surgery to remove lymph nodes is called a lymph node dissection or lymphadenectomy. Salivary gland cancers sometimes spread to lymph nodes in the neck (cervical lymph nodes), and these may need to be removed as a part of treating the cancer. This is called a neck dissection.

A neck dissection may be done if:

• Lymph nodes in the neck are enlarged (which may be felt or seen on a CT or MRI scan)
• A PET (positron emission tomography) scan suggests the lymph nodes may contain cancer
• The cancer is high grade (looks very abnormal under the microscope) or has other features that mean it has a high risk of spreading

The removed lymph nodes are looked at under the microscope to see if they contain cancer cells. Taking out the lymph nodes can help ensure all of the cancer is removed. It can also be important for staging and deciding if more treatment is needed.

There are many types of neck dissections, but their major purpose is to remove lymph nodes that might contain cancer. In doing this, the surgeon may need to remove nearby connective tissue, muscles, nerves, and blood vessels from one side of your neck. This type of surgery is usually done through an incision (cut) across the side of the neck, but sometimes a longer incision going down the neck might be needed.

Possible risks and side effects of lymph node removal

The general risks of a neck dissection are much like those with any other type of surgery, including problems with anesthesia, bleeding, blood clots, infections, and poor wound healing. Most people will have some pain afterwards , but this can usually be controlled with pain medicines.

Because this surgery can affect nerves that run through the neck, it can sometimes lead to ear numbness, weakness in raising your arm above your head, and weakness of the lower lip. These may get better with time. You can be helped by physical therapists who can teach you exercises to improve your neck and shoulder movement.

Sentinel lymph node biopsy

Sentinel lymph node mapping and biopsy has become a common way to find out whether a cancer has spread to the lymph nodes. It may be used in certain types of salivary gland cancer, and can help keep you from needing neck dissection. This procedure can find the lymph nodes that drain lymph fluid from the salivary gland where the cancer started. These lymph nodes are usually the first place cancer will go. The surgery involves taking out these lymph nodes and checking them for cancer during the surgery. If no cancer cells are found, the other lymph nodes can be left alone. If these nodes do have cancer cells in them, neck dissection is usually needed.  

For more general information on surgery, see Cancer Surgery.

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If a cancer comes back after treatment it is called a “recurrence.” But some cancer survivors may develop a new, unrelated cancer later. This is called a “second cancer.” No matter what type of cancer you have had, it is still possible to get another (new) cancer, even after surviving the first.

Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer. People who have had cancer can still get the same types of cancers that other people get. In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.

Survivors of salivary gland cancers can get any second cancer, but they have an increased risk of:

• Another salivary gland cancer (this is different than the first cancer coming back)
• Cancer of the oral cavity (mouth)
• Lung cancer
• Thyroid cancer

Follow-up after treatment

After completing treatment for salivary gland cancer, you should still see your doctor regularly. Your doctor may order tests to look for signs that the cancer has come back or spread. These tests are also useful in finding some second cancers, particularly a new salivary gland cancer or lung cancer. Experts don’t recommend any other tests to look for second cancers in patients who don’t have symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors of salivary gland cancers should follow the American Cancer Society guidelines for the early detection of cancer and stay away from tobacco products. Smoking increases the risk of getting certain second cancers as well as other health problems.

To help maintain good health, survivors should also:

• Achieve and maintain a healthy weight
• Adopt a physically active lifestyle
• Consume a healthy diet, with an emphasis on plant foods
• Limit consumption of alcohol to no more than 1 drink per day for women or 2 per day for men

These steps may also lower the risk of some cancers.

See Second Cancers in Adults for more information about causes of second cancers.

It’s important to have honest, open discussions with your doctor. Ask any question, no matter how small it might seem. Here are some questions you might want to ask. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions.

• What kind of salivary gland cancer do I have?
• Which salivary gland is affected?
• Is my cancer high grade (likely to grow and spread quickly) or low grade?
• Has my cancer spread beyond where it started?
• What is my cancer’s stage, and what does that mean?
• Will I need other tests before we can decide on treatment?
• Will I need to see other doctors?
• How much experience do you have treating this type of cancer?
• Should I get a second opinion? Can you recommend a doctor or cancer center?
• What are my treatment choices?
• What treatment do you recommend and why?
• What’s the goal of the treatment?
• What are the chances my cancer can be cured with treatment?
• How quickly do we need to decide on treatment?
• What should I do to be ready for treatment?
• How long will treatment last? What will it be like? Where will it be done?
• What risks or side effects should I expect? How long are they likely to last?
• Is treatment likely to affect my speech or swallowing?
• Will treatment affect the way I look?
• How will treatment affect my daily activities?
• What will we do if the treatment doesn’t work or if the cancer recurs?
• What type of follow-up might I need after treatment?
• Where can I find more information and support?

Along with these sample questions, be sure to write down some of your own. For instance, you might want more information about your recovery time so you can plan your work schedule. Or you might want to ask about clinical trials for which you may qualify. You can find more information about communicating with your health care team in The Doctor-Patient Relationship.

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

A few risk factors are known to make a person more likely to develop salivary gland cancer.

Older age

The risk of salivary gland goes up as people get older.

Male gender

Salivary gland cancers are more common in men than in women.

Radiation exposure

Radiation treatment to the head and neck area for other medical reasons increases your risk of salivary gland cancer.

Workplace exposure to certain radioactive substances may also increase the risk of salivary gland cancer.

Family history

Very rarely, members of some families seem to have a higher than usual risk of developing salivary gland cancers. But most people who get salivary gland cancer do not have a family history of this disease.

Other possible risk factors

Certain workplace exposures

Some studies have suggested that people who work with certain metals (nickel alloy dust) or minerals (silica dust), and people who work in asbestos mining, plumbing, rubber products manufacturing, and some types of woodworking may be at increased risk for salivary gland cancer, but these links are not certain. The rarity of these cancers makes this hard to study.

Tobacco and alcohol use

Tobacco and alcohol can increase the risk for several cancers of the head and neck area, but they have not been strongly linked to salivary gland cancers in most studies.

Diet

Some studies have found that a diet low in vegetables and high in animal fat may increase the risk of salivary gland cancer, but more research is needed to confirm this possible link.

Cell phone use

One study has suggested an increased risk of parotid gland tumors among heavy cell phone users. In this study, most of the tumors seen were benign (not cancer). Other studies looking at this issue have not found such a link. Research in this area is still in progress.

Although we know a few things that can raise a person’s risk of salivary gland cancer, it’s not clear exactly what causes most of these cancers.

Cancer is caused by changes in the DNA inside of cells. DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. However, DNA affects more than how we look. It also can influence our risk for developing certain diseases, such as some kinds of cancer.

Some genes help control when cells grow, divide into new cells, and die. Genes that help cells grow, divide, and stay alive are called oncogenes. Genes that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. Changes in several different genes are usually needed for a cell to become cancer.

Researchers don’t yet know all of the DNA changes that result in salivary gland cancer, but they have found some gene changes that are often found in these cancers.

Salivary gland cancer does not usually run in families, so most of the DNA changes that lead to this cancer are not likely to be inherited from a person’s parents. Instead, these changes probably take place during a person’s lifetime. Sometimes these changes might just be random events that happen inside cells, without having an outside cause. But sometimes the cause might be something specific, like exposure to radiation or certain carcinogens (cancer-causing chemicals).

Because we don’t know what causes most salivary gland cancers, we don’t yet know how to prevent many of them.

Avoiding some of the possible risk factors (such as tobacco, excess alcohol use, and unhealthy diets) might slightly lower the likelihood of developing salivary gland cancer, but no one knows for sure. However, we do know that avoiding these factors can help reduce your risk of other, more common cancers, as well as many other diseases.

For people who work in certain industries linked with an increased risk of salivary gland cancer, taking precautions to protect themselves might help lower their risk.

Salivary gland cancer is not common, so doctors do not recommend testing for it unless someone has symptoms. Still, because of its location, in many cases salivary gland cancer can be found early. Often patients, their dentists, or their doctors notice a lump within one of the salivary glands (usually on the sides of the face or in the mouth). Checking the salivary glands for tumors is often a routine part of general medical and dental check-ups.

Being alert to possible signs and symptoms of salivary gland cancers and not ignoring them might help find these cancers early, when treatment is likely to be most effective.