DONATESALIVARY GLAND CANCER
Salivary Gland Cancer Treatment
The salivary glands are often overlooked structures within the head and neck until a clinical concern arises. Although salivary gland cancers are relatively uncommon compared to other head and neck malignancies, they are clinically important due to their biological diversity and the need for specialised management. Many salivary gland tumours develop slowly and remain painless in the early stages, which can delay recognition. This makes awareness of their presentation and timely evaluation particularly important.
At RGCIRC (Rajiv Gandhi Cancer Institute and Research Centre), salivary gland cancer is managed by a dedicated Head and Neck Surgical Oncology team within a multidisciplinary care framework.
What are the Salivary Glands?
The salivary glands are exocrine glands distributed throughout the mouth and throat that produce saliva. Saliva keeps the mucosal surfaces of the mouth and throat moist, initiates the digestion of food, and protects the teeth and oral mucosa. There are three pairs of major salivary glands and hundreds of minor salivary glands distributed across the oral cavity and upper aerodigestive tract.
Parotid Glands
The parotid glands are the largest of the three major salivary gland pairs, located in front of and just below each ear, extending towards the angle of the jaw. They primarily produce a serous (watery) type of saliva, which drains into the mouth through Stensen’s duct, opening opposite the upper second molar teeth.
Approximately 70–80% of all salivary gland tumours arise in the parotid gland. A key clinical consideration is the presence of the facial nerve, which passes through the gland and controls the muscles of facial expression. This anatomical relationship makes parotid tumours particularly important in surgical planning, as preserving nerve function is central to achieving optimal functional outcomes.
Submandibular Glands
The submandibular glands are located beneath the lower jaw on each side and produce a mixed serous and mucous type of saliva. They represent the second most common site for salivary gland tumours.
Sublingual Glands
The sublingual glands are the smallest of the major pairs, located in the floor of the mouth beneath the tongue. They produce primarily mucous saliva and drain through multiple small ducts into the floor of the mouth. Tumours of the sublingual gland are uncommon but carry a higher rate of malignancy than parotid tumours.
Minor Salivary Glands
Several hundred minor salivary glands are distributed throughout the lining of the oral cavity, including the hard and soft palate, buccal mucosa, lips, floor of the mouth, and tongue, as well as parts of the upper aerodigestive tract such as the larynx.
Despite their small size, tumours arising from these glands are clinically significant. They have a higher likelihood of being malignant compared to tumours of the major salivary glands. Clinically, they often present as painless swellings, particularly on the palate or oral mucosa, which warrants careful evaluation and timely diagnosis.
What is Salivary Gland Cancer?
Salivary gland cancer refers to malignant tumours that arise from the cells of the salivary glands, whether major or minor. It is an uncommon malignancy, accounting for less than 1% of all cancers globally and approximately 3–5% of head and neck cancers.
Among all salivary gland tumours, the majority – around 84% – are benign, while approximately 16% are malignant. However, this distribution varies by gland. The parotid gland has the highest proportion of benign tumours, whereas smaller glands, such as the sublingual and minor salivary glands, carry a relatively higher risk of malignancy.
Benign Salivary Gland Tumours
- ●Pleomorphic Adenoma: Pleomorphic adenoma is the most common salivary gland tumour overall, accounting for approximately 60–65% of all parotid tumours. It is typically a slow-growing, well-circumscribed lesion that presents as a painless swelling in the parotid region. Although classified as benign, it carries a recognised risk of malignant transformation, known as carcinoma ex pleomorphic adenoma, particularly if left untreated for a prolonged period or if incompletely excised. This underlines the importance of timely diagnosis and appropriate surgical management.
- ●Warthin Tumour: The second most common benign parotid tumour. It occurs almost exclusively in the parotid gland, is more common in men, and has a strong association with tobacco use. Warthin tumours are bilateral in approximately 10% of cases and are characteristically located in the lower pole of the parotid.
- ●Basal Cell Adenoma: It occurs most frequently in the parotid gland and carries a very low risk of malignant change.
- ●Canalicular Adenoma: It is typically small, painless, and submucous in location.
- ●Oncocytoma: A rare benign tumour composed of large cells with abundant granular cytoplasm (oncocytes). It occurs predominantly in older adults and most commonly in the parotid gland.
Malignant Salivary Gland Tumours
The most clinically relevant malignant subtypes include:
- ● Mucoepidermoid Carcinoma: The most frequent malignant salivary gland tumour, accounting for approximately 51% of malignant cases. It arises from ductal cells and is graded as low, intermediate, or high – a distinction that significantly influences prognosis and treatment intensity. Low-grade tumours carry an excellent prognosis after surgical excision; high-grade tumours behave more aggressively and may require adjuvant radiation.
- ●Adenoid Cystic Carcinoma: One of the most clinically challenging salivary gland malignancies. It is characterised by perineural invasion, the tendency to spread along nerve sheaths, which makes achieving clear surgical margins difficult and contributes to its propensity for local recurrence. It has a slow but relentless course, and distant metastasis, particularly to the lungs, can occur years or even decades after initial treatment.
- ●Acinic Cell Carcinoma: A low- to intermediate-grade malignancy arising from acinar cells, most commonly in the parotid gland. It carries a generally favourable prognosis with appropriate surgical treatment, though late recurrence is possible.
- ●Adenocarcinoma: A broad category of malignant tumours arising from glandular epithelium, not otherwise specified. Behaviour varies depending on grade.
- ●Carcinosarcoma (Malignant Mixed Tumour): A rare, aggressive malignancy with both carcinomatous and sarcomatous elements. It carries a poor prognosis and requires aggressive multimodal treatment.
- ●Oncocytic Carcinoma: A rare malignant counterpart of oncocytoma, with aggressive behaviour and a significant risk of metastasis.
- ●Clear Cell Carcinoma: A rare low-grade malignancy composed of cells with clear cytoplasm, occurring most commonly in the minor salivary glands of the oral cavity.
Signs and Symptoms of Salivary Gland Cancer
Many salivary gland tumours – both benign and malignant – present as a painless, gradually enlarging swelling. This may occur in the parotid region (in front of or below the ear), the submandibular region (beneath the jaw), or within the oral cavity, most commonly on the palate. The absence of pain does not exclude malignancy, as several low-grade salivary gland cancers can remain painless for prolonged periods.
- ● A swelling or lump in front of the ear, below the jaw, or in the floor of the mouth or palate, with or without pain
- ● Weakness or numbness affecting one side of the face – a particularly important sign, as facial nerve involvement suggests either parotid malignancy or a large benign tumour causing nerve compression
- ● Persistent pain in the face, jaw, neck, or oral cavity that does not resolve
- Difficulty opening the mouth fully or restricted movement of the jaw (trismus)
- ● Difficulty swallowing (dysphagia)
- ● A change in voice quality or hoarseness, particularly for tumours of the minor salivary glands of the larynx or pharynx
- ● Bleeding from the mouth or a non-healing oral mucosal lesion overlying a palate swelling
- Swelling of lymph nodes in the neck, which may indicate regional spread
Risk Factors of Salivary Gland Cancer
The exact cause of most salivary gland cancers is not fully understood. Several factors, however, have been associated with an increased risk of developing salivary gland tumours – both benign and malignant.
Ionising Radiation
Exposure to ionising radiation, whether from previous therapeutic radiation to the head and neck region, or from environmental or occupational sources, is one of the most clearly established risk factors for salivary gland malignancy. This includes individuals who received radiation treatment for previous head and neck cancers and those with a history of therapeutic radiation in childhood.
Viral Infections
Certain viruses have been implicated in the development of specific salivary gland tumours. Epstein-Barr virus (EBV) has been associated with lymphoepithelial carcinoma of the salivary glands, particularly in populations of South-East Asian origin. Cytomegalovirus (CMV) and polyoma viruses have also been studied in relation to salivary gland tumourigenesis.
Occupational Exposures
Prolonged occupational exposure to certain industrial substances, including asbestos, nickel compounds, silica dust, and chemicals used in rubber and wood processing industries, has been associated with a modestly elevated risk of salivary gland tumours in epidemiological studies.
Tobacco Use
Smokers are significantly more likely to develop Warthin tumours than non-smokers, and the association is dose-dependent.
Hormonal Factors
The mechanisms are not fully established.
Age and Sex
Prior Head and Neck Cancer
How is Salivary Gland Cancer Diagnosed?
Accurate diagnosis of a salivary gland tumour requires a systematic clinical, radiological, and pathological evaluation.
- Ultrasound: The first-line imaging modality for parotid and neck masses. It defines the size, location, and internal characteristics of the lesion and guides fine needle aspiration cytology (FNAC).
- CT Scan: Provides detailed anatomical information about the tumour’s extent, bone involvement, and regional lymph node status. It is particularly useful for tumours of the deep lobe of the parotid and submandibular gland.
- MRI: Offers superior soft tissue resolution compared to CT and is the preferred modality for assessing perineural spread, particularly relevant for adenoid cystic carcinoma, and for planning surgery in the parotid region where the facial nerve’s course needs to be mapped.
- PET-CT: Reserved for selected cases of advanced or high-grade malignancy where distant metastatic staging is clinically indicated.
Tissue Diagnosis
● Core Needle Biopsy or Open Biopsy: In cases where FNAC is non-diagnostic or inconclusive, a core needle biopsy or incisional biopsy may be required to obtain sufficient tissue for histological and molecular analysis.
How is Salivary Gland Cancer Treated?
Treatment for salivary gland cancer is individualised and depends on the tumour’s histological subtype, grade, stage, anatomical location, and the patient’s overall health and functional status.
At RGCIRC, each case is reviewed in a multidisciplinary tumour board comprising head and neck surgical oncologists, medical oncologists, radiation oncologists, onco-pathologists, and imaging specialists. This collaborative approach ensures that every treatment plan is carefully tailored and clinically appropriate. Treatment protocols are aligned with National Comprehensive Cancer Network (NCCN) guidelines to maintain consistency with international standards of care.
How is Salivary Gland Cancer Treated?
Treatment for salivary gland cancer is individualised and depends on the tumour’s histological subtype, grade, stage, anatomical location, and the patient’s overall health and functional status.
At RGCIRC, each case is reviewed in a multidisciplinary tumour board comprising head and neck surgical oncologists, medical oncologists, radiation oncologists, onco-pathologists, and imaging specialists. This collaborative approach ensures that every treatment plan is carefully tailored and clinically appropriate. Treatment protocols are aligned with National Comprehensive Cancer Network (NCCN) guidelines to maintain consistency with international standards of care.
Surgery
- ●Superficial Parotidectomy: Removal of the superficial lobe of the parotid gland with preservation of the facial nerve. This is typically indicated for benign tumours and low-grade malignancies confined to the superficial lobe.
- Total Conservative Parotidectomy: Removal of the entire parotid gland while preserving the facial nerve, where oncologically feasible. This approach is used for deeper or more extensive parotid tumours.
- ●Radical and Extended Radical Parotidectomy: Removal of the parotid gland with sacrifice of the facial nerve when the nerve is involved by tumour. Facial nerve sacrifice is undertaken only when it is essential for complete tumour clearance.
- ●Facial Nerve Repair and Facial Reanimation: In cases where the facial nerve must be sacrificed, reconstruction is performed using nerve grafts and facial reanimation procedures. Both static and dynamic techniques are employed to restore facial symmetry and function as far as possible.
- ●Submandibular Gland Resection: Excision of the submandibular gland along with surrounding tissue, with careful preservation of adjacent nerves wherever feasible.
- ●Neck Dissection: Removal of regional lymph nodes in the neck is performed when lymph node involvement is confirmed or clinically suspected. In selected high-risk cases, it may also be carried out electively to address occult nodal disease.
- ● Maxillectomy: Indicated for tumours arising from minor salivary glands of the palate, particularly when there is involvement of the hard palate or adjacent structures.
Radiation Therapy
Postoperative radiation therapy is recommended in the majority of malignant salivary gland cancers, particularly in the presence of high-risk features such as high-grade tumours, close or positive surgical margins, perineural invasion, lymphovascular invasion, or lymph node involvement.
At RGCIRC, radiation is delivered using advanced techniques such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). These approaches allow precise targeting of the tumour bed and regional lymphatics while minimising exposure to surrounding critical structures.
In cases where the tumour is unresectable, radiation therapy – often in combination with chemotherapy – may be used as the primary treatment modality.
Chemotherapy
Chemotherapy has a limited but well-defined role in the management of salivary gland cancer.
Targeted Therapy
At RGCIRC, molecular testing of tumour tissue is routinely offered to identify patients who may benefit from targeted therapy, particularly in the recurrent or metastatic setting.
Immunotherapy
Its role continues to evolve as clinical evidence expands, and patient selection remains critical to achieving optimal outcomes.
Salivary Gland Cancer Care at RGCIRC
At RGCIRC, patients benefit from a comprehensive, evidence-based approach that spans diagnosis, treatment, reconstruction, and long-term follow-up.
1. Experienced Head and Neck Surgical Oncology Team
2. Multidisciplinary Tumour Board Approach
3. Advanced Diagnostic Infrastructure
4. Reconstructive and Functional Restoration
5. Accreditation and Patient Support
RGCIRC is accredited by NABH (5th Edition) and NABL for its diagnostic services, reflecting adherence to stringent quality and safety standards. Institute also works to ensure that financial constraints do not limit access to specialised cancer care.
Book a Consultation at RGCIRC
If you have a neck or facial swelling, an oral cavity mass, or have been referred with a suspected salivary gland tumour, our Head and Neck Surgical Oncology team is available for assessment.
Call +91-11-4702 2222 (Rohini) / +91-11-4582 2222 (Niti Bagh, South Delhi) Book online at care.rgcirc.org | Download the RGCI Care app on iOS and Android OPD Hours: Monday to Saturday, 9:00 AM to 5:00 PM | Emergency Services: 24×7 at both campuses
Frequently Asked Questions (FAQs)
Is salivary gland cancer curable?
Early-stage, low-grade tumours are often curable with surgery, with or without radiation. Prognosis depends on subtype, grade, and stage. Early treatment at a specialist centre improves outcomes.
What is the survival rate of salivary gland cancer?
Survival varies by type and stage. Early, low-grade tumours have five-year survival rates above 90%, while advanced or high-grade cancers have lower survival.
Is surgery necessary for salivary gland tumours?
In most cases, yes. Surgery is the primary treatment for both benign and malignant tumours to remove the lesion and prevent progression.
Can salivary gland cancer spread to other organs?
Yes. It can spread to neck lymph nodes and, in advanced cases, to the lungs, liver, or bones.
How long does recovery take after treatment?
Recovery ranges from 2–4 weeks for minor procedures to 4–8 weeks or longer for extensive surgery, depending on treatment complexity.
How do I find the best salivary gland cancer doctor near me?
RGCIRC offers specialised care through its Head and Neck Surgical Oncology team in Delhi, with in-person and teleconsultation options.
Is salivary gland cancer hereditary?
Most cases are not hereditary, and family history does not significantly increase risk.
Is chemotherapy effective for salivary gland cancer?
Chemotherapy has a limited role and is mainly used in advanced or metastatic disease, often alongside other treatments.
Are there lifestyle changes that reduce risk?
Avoiding tobacco and limiting exposure to harmful chemicals are the most relevant preventive measures.
Can smoking cause salivary gland cancer?
Smoking is strongly linked to Warthin tumour (benign) and increases overall head and neck cancer risk.
The parotid glands are the largest of the three major salivary gland pairs, located in front of and just below each ear, extending towards the angle of the jaw. They primarily produce a serous (watery) type of saliva, which drains into the mouth through Stensen’s duct, opening opposite the upper second molar teeth.
Approximately 70–80% of all salivary gland tumours arise in the parotid gland. A key clinical consideration is the presence of the facial nerve, which passes through the gland and controls the muscles of facial expression. This anatomical relationship makes parotid tumours particularly important in surgical planning, as preserving nerve function is central to achieving optimal functional outcomes.
