Salivary Gland Cancer Tests

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 American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: September 28, 2017 Last Revised: September 28, 2017

National Cancer Institute. Salivary Gland Cancer Treatment (PDQ)-Health Professional Version. December 21, 2016.

National Comprehensive Cancer Network. Head and Neck Cancers. NCCN Clinical Practice Guidelines in Oncology. Version 2.2017--May 8, 2017.

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