Salivary Gland Cancer

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Tests for Salivary Gland Cancer

Salivary gland cancer is usually found when a person goes to a doctor because they are having symptoms.

If your health care team suspects you have a salivary gland tumor, they will need to do more tests to confirm the diagnosis. If a salivary gland cancer is found, they will do other tests to learn more about it.

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Medical history and physical exam

Your health care team will take a complete medical history to find out more about your symptoms. They might also ask you about any possible risk factors for developing a salivary gland cancer, such as any previous cancers or cancer treatment, and about your overall health.

Initially, the health care team will examine you, looking for signs that point to a cause of your symptoms. During the physical exam, they might:

  • Look at or feel an area of swelling or a lump
  • Look inside your mouth, including the roof of your mouth, cheeks, and under your tongue
  • Feel the sides of your face around your ears and jaw, as well as your neck, to feel for any large lymph nodes (lumps under the skin)
  • Check how your face moves and assess for numbness, which can happen if cancer spreads to the nerves

Exam by a specialist

If the cause of these symptoms is unclear, or cancer is suspected, your doctor will refer you to a specialist.

Specialists that care for people with salivary gland tumors are oral and maxillofacial surgeons or head and neck surgeons. They are also known as ear, nose, and throat (ENT) doctors or otolaryngologists. The specialist will most likely do a complete head and neck exam and might order other exams and tests.

Because salivary glands are throughout the mouth and throat, some are not easy to see. The specialist might use different techniques to examine the area:

  • Indirect pharyngoscopy and laryngoscopy. Small mirrors on long, thin handles are used to look at your throat, the base of your tongue, and part of the larynx (voice box).
  • Direct (flexible) pharyngoscopy and laryngoscopy. A flexible fiber-optic scope called an endoscope is put in through your mouth or nose to get a clearer look at areas that can’t easily be seen with mirrors. It can also look at the part behind the nose (nasopharynx) and the larynx (voice box).

These exams can be done in the doctor’s office. The doctor might first spray the back of your throat with numbing medicine to help make the exam easier.

After the physical exam

After the exam, if cancer is suspected, the health care team will do more tests. These might include:

  • Imaging tests
  • Biopsies (small tissue samples)
  • Blood tests

These tests are important because many of the symptoms and signs of salivary cancer can be caused by other things, like infection, inflammation, or benign (noncancerous) tumors.

Imaging tests

Imaging tests are used to create pictures of the inside of your body. Imaging tests might be done for a number of reasons. They can help your health care team:

  • Find out if a suspicious area might be cancer
  • Determine if a cancer might have started in another part of your body
  • Learn how far cancer has spread
  • Determine if treatment is working
  • Look for possible signs of cancer coming back after treatment

If you have salivary gland cancer, or if your health care team suspects you might have it, you will get one or more of the following tests. You might not need all of them.

A CT scan combines many x-rays to make detailed cross-sectional images of the inside of your body. Before the test, you might get an IV injection of a contrast dye to help get a clearer picture.

CT scans can:

  • Show the size, shape, and exact location of a tumor
  • Help find enlarged lymph nodes nearby that might have cancer
  • Look for tumor spread in other parts of the body, like the lungs.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a tumor to find out if it is cancer. For this test, you stay on the CT scanning table while the doctor moves a biopsy needle toward the tumor. CT scans are repeated until the tip of the needle is within the mass.

An MRI creates detailed images of the soft tissues inside your body. This is done using radio waves and strong magnets instead of x-rays, so there is no radiation. A contrast material called gadolinium might be injected into your vein before the scan to see details better. An MRI scan usually shows better details than a CT scan.

MRIs can be used to:

  • Look at an abnormal area found on physical examination or other imaging tests and provide more detail about the mass.
  • Help doctors see how much cancer is in your body (the extent of a tumor).

MRI is often the best imaging test for a suspected salivary gland tumor. This type of imaging shows the tumor, soft tissues around the tumor, as well as nearby blood vessels and nerves.

If you have weakness or numbness in your face, an MRI scan can help see if any of the nearby nerves or muscles are affected by cancer or if the cancer is close to the skull bone. MRI scans are also helpful to look for cancer spread to the brain or spinal cord.

Ultrasounds use sound waves and their echoes to look inside the body. For this test, a small, wand-like instrument called a transducer is moved around on the skin, which creates an image that can be seen on a computer screen. The test uses no radiation and does not cause any pain.

Ultrasounds can be used to get a better look at the major salivary glands or lymph nodes in the neck and might be used to get a biopsy of a suspicious area. It might also be used after treatment to look for signs of cancer coming back (recurrence).

Newer measures by ultrasound, such as elastography, might be helpful in deciding if a tumor is likely cancer. For elastography, the transducer is applied to the tumor or swelling with some pressure, and measures are taken of how much the tumor tissue compresses and expands as the pressure is applied. Cancers tend to be stiffer than benign tumors.

Contrast can also be used with ultrasound to see the features of a salivary gland tumor better.

Biopsy

In many cases, the only way to know for sure if a person has salivary gland cancer is to get a biopsy (a small sample) from the tumor and look at it in the lab.

Different types of biopsies might be done, depending on the situation.

An FNA biopsy uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of fluid and very small pieces of tissue from a lump or tumor for testing.

FNA biopsies are sometimes done on a lump in the salivary gland or on a suspicious lymph node in the neck. In some cases, this type of biopsy can help a person avoid surgery.

How it’s done

If the tumor is near the surface of the body, the doctor can aim the needle while feeling the lump. If the tumor is deeper inside the body, the needle can be guided into place using an imaging test, such as an ultrasound or CT scan.

Your doctor might first numb the area over the tumor. The doctor then puts the needle into the tumor and pulls cells and a few drops of fluid into a syringe. The sample is then sent to a lab. The FNA biopsy might show whether the lump is caused by an infection, a benign salivary tumor, or salivary gland cancer.

Limitations

An FNA biopsy is only helpful if enough cells are taken out to check. Sometimes not enough cells are removed, or the biopsy is read as negative (normal) even when the tumor is cancerous. If the doctor is not sure about the FNA biopsy results, a different type of biopsy might be needed to get more cells and tissue.

If the FNA biopsy cannot get enough cells to test, the doctor might do a core needle biopsy that uses a hollow needle to take out pieces of tissue from a suspicious area. This type of biopsy removes more tissue than an FNA biopsy. Often an ultrasound is used to guide the needle.

A small cylinder (core) of tissue is taken out in the needle. Several cores are often removed and sent to the lab to be tested.

This type of biopsy might be done if the FNA biopsy didn't get a large enough sample. The biopsy might be done either in the doctor’s office or in the operating room, depending on where the tumor is and how easy it is to get a good tissue sample.

In this procedure, the surgeon numbs the area over the tumor, makes a small cut (incision) with a scalpel (small knife), and cuts out a piece of the tumor.

If the tumor is deep inside the mouth or throat, the biopsy might be done in the operating room while you are in a deep sleep under general anesthesia. These types of biopsies are not done often for salivary gland tumors.

An excisional biopsy is surgery to remove the tumor completely. The doctor might advise this if an FNA biopsy doesn’t provide a clear answer, but the physical exam and imaging tests suggest that it is cancer. This can give enough of a sample for a diagnosis and treat the tumor at the same time.

In some cases, if the exams and tests suggest cancer, the doctor might skip the FNA biopsy altogether and recommend removing the tumor. The entire tissue sample that is removed is then sent to the lab to confirm the diagnosis.

See Surgery for Salivary Gland Cancer for more information.

Lab tests on biopsy samples

All biopsy samples are sent to a lab to be tested. A doctor called a pathologist will look at them with a microscope to find out if they contain cancer cells, and if so, what type.

For certain types of salivary gland cancers that have spread, molecular tests to look for certain proteins or gene changes might be done to help choose targeted drugs or immunotherapy drugs for treatment.

Androgen receptor: This is a protein on some salivary gland cancer cells that androgens, a type of hormone, bind to and help the cancer grow. Drugs called anti-androgens target these proteins and can help slow the tumor growth.

HER2: This is a protein on some salivary gland cancer cells that helps the cancer grow. These cancers can be treated with drugs that block HER2.

NTRK fusion gene: This is a gene change (mutation) in one of the NTRK genes. Cells with these gene changes can lead to abnormal cell growth and cancer. There are targeted drugs available that target cells with NTRK gene changes.

Tumor mutational burden (TMB): TMB is a measure of the number of gene changes inside the cancer cells. Cancer cells that have many gene changes (a high TMB or TMB-H) might be more likely to be recognized as abnormal and attacked by the body’s immune system. If your cancer tissue is tested and found to have a high TMB (TMB-H), treatment with a certain immunotherapy drug might be an option.

Blood tests

Your doctor might order routine blood tests to get an idea of your overall health, especially before treatment. Such tests can help diagnose poor nutrition and low blood cell counts.

A complete blood count (CBC) measures the levels of white blood cells, red blood cells, and platelets in your blood. This test can be used during treatment or before treatment to check for possible problems or side effects.

Blood chemistry tests can be used to measure how well your liver or kidneys are working, as well as the levels of certain minerals in your blood. This is often checked before surgery or chemo.

Coagulation testing can be done to see if your blood is able to clot normally, which is especially important before surgery.

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Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).

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Last Revised: March 11, 2026

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