How is salivary gland cancer found?

Salivary gland cancer is rare, so doctors do not recommend testing for it unless a person has symptoms. Still, because of where it starts, in many cases it can be found early. Often patients, their dentists, or their doctors notice a lump in one of the salivary glands--usually on the side of the face or in the mouth. And checking the salivary glands for lumps is often a part of medical and dental check-ups.

Finding the cancer early greatly increases the chances of a cure. If you have any of the problems listed below, see a doctor right away:

• A mass or lump in your face, neck, or mouth
• Pain in one place in your face, neck, or mouth that doesn’t go away
• A difference in the size or shape of the left and right sides of your face or neck that wasn't there before
• Numbness in part of your face
• New muscle weakness on one side of your face
• Trouble swallowing

These are symptoms salivary gland cancer, but they may also be caused by something else. Still, if you have any of these problems, it's important to see a doctor right away so the cause can be found and treated, if needed.

Doctor’s visit

If there is any reason to suspect salivary gland cancer, there are steps the doctor will take to find out if you really have the disease. After asking questions about your health, the doctor will do a physical exam. The doctor will pay special attention to how the glands feel and whether or not there is any weakness or numbness in the face.

If the standard exam shows anything that is not normal, your doctor may do more tests or refer you to a doctor with special training in ear, nose, and throat problems (an otolaryngologist) to do a more detailed exam.

Imaging tests

Imaging studies use x-rays and other methods to take pictures of the inside of your body. Imaging tests may be done for a number of reasons -- to help find something that might be cancer, to learn how far cancer may have spread, or to see if treatment is working.

X-rays: If you have a lump near your jaw, the doctor may do x-rays of the jaws and teeth to look for a tumor. An x-ray of the chest can show whether the cancer has spread to the lungs. It also gives information about your heart and lungs that might be useful if surgery is needed.

CT (computed tomography) scan: A CT scan is a special kind of x-ray that takes pictures of the body from many angles. A computer combines these pictures to form one detailed picture. CT scans are useful in finding many types of tumors.

Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. You may also have an IV (intravenous) line through which you are given a different kind of contrast dye (IV contrast). The dye helps better outline structures in your body.

CT scans take longer than regular x-rays and you need to lie still on a table while they are being done. Also, you might feel a bit confined by the ring-shaped machine that goes around the table.

The CT scan can tell the doctor about the size, shape, and place of a tumor and can help find swollen lymph nodes that might contain cancer.

MRI (magnetic resonance imaging) scan: An MRI, like a CT scan, makes a cross-sectional picture of the body. But the MRI uses radio waves and strong magnets instead of x-rays. MRI scans take longer than CT scans -- often up to an hour. The MRI machine makes loud clicking sounds as it takes pictures. Some people find this disturbing. The machine you are placed inside is like a large narrow tube. It is confining and can upset people with a fear of enclosed spaces. Special, open MRI machines can help with this if needed. MRI scans can help find the exact place and extent of a tumor. Sometimes they can help a doctor tell if a tumor is cancer.

PET (positron emission tomography) scan: PET involves putting a form of sugar that contains a radioactive atom into the blood. Cancer cells in the body take in large amounts of the sugar and a special camera can show the radioactivity. This test is useful to see if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread but doesn’t know where. PET scans can be used instead of several different x-rays because they scan your whole body. Some machines combine a CT scan and a PET scan to even better pinpoint the cancer.

Biopsy

Once a tumor is found, a biopsy will be done to find out what kind it is. A type of biopsy called fine needle aspiration (FNA) is most often done. After numbing the skin, the doctor places a thin needle into the gland and pulls out some cells and fluid. The cells are looked at under a microscope to see if they contain cancer cells. But a negative biopsy doesn’t always mean that there is no cancer. For instance, the needle may not have removed enough cells to tell for sure.

FNA biopsy may not always give a clear answer. If the physical exam and imaging tests suggest that cancer may be present, the doctor may advise surgery to remove all or part of the tumor. This will give enough of a sample to tell if cancer is present. Taking out the whole tumor is also a way to treat the tumor.