Treatment Options by Stage of Salivary Gland Cancer

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

Since salivary gland cancers are rare and can be hard to treat, clinical trials might be a good option to think about.

Stage I

These cancers are small and still just in 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 might 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, if the edges of the removed area have cancer cells (a sign that some cancer might have been left behind), or if the cancer is invading (growing into) nearby nerves.

Stage II

Stage II salivary gland cancers are larger but are still just in 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, especially if the main tumor is high-grade.

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, if the cancer is invading nearby blood vessels, lymph vessels, or nerves; if the removed lymph nodes have cancer; or if the edges of the removed tissue contain cancer cells. Chemotherapy might be given along with radiation in certain cases, but this combination treatment is still being studied. 

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 and IVA

These cancers are even larger and/or have started to grow outside the salivary gland into nearby structures. They might have also spread to lymph nodes in the neck on the same side as the cancer or both sides of the neck.

Doctors generally recommend extensive surgery (removing the salivary gland containing the tumor, nearby tissues, and 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 other cases, especially for high-grade tumors or adenoid cystic cancer, surgery is often 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, or if someone is not healthy enough to have surgery).

Stage IVB

Stage IVB 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 to try to shrink the tumor(s) and relieve pain, bleeding, or other symptoms. Radiation might be combined with chemo. If the cancer has spread to other parts of the body, chemo or targeted drug therapy might shrink or slow the growth of the cancer for a time and may help relieve symptoms caused by the cancer.

Because these cancers are rare and can be hard to treat, taking part in a clinical trial is a good option.

Treatment of recurrent salivary gland cancer

Cancer is called recurrent if it comes back after treatment. Cancer can come back locally (in or near the same place it started) or distantly (spread to organs such as the lungs or liver).

If cancer returns after treatment, your choices depend on the location and the extent of the cancer as well as what treatment was used the first time. It’s important to understand the risks and benefits and goals of further treatment – whether it’s to try to cure the cancer or to help relieve symptoms.

If the cancer recurs locally and is thought to be resectable (able to be removed completely), surgery is usually the treatment of choice. This is often followed by radiation therapy if it wasn’t given before.

If the cancer returns in the area where it started (local) but is not resectable, radiation therapy may be an option. Chemotherapy (chemo) might be used along with the radiation or by itself (especially if radiation therapy was already used the first time).

Salivary gland cancers that come back in distant parts of the body are usually treated with chemo or targeted drug therapy. In some cases, other treatments such as surgery or radiation might be used to help relieve symptoms from the spread of the cancer or to treat a small number of tumors that might be growing in certain organs like the lungs. If the cancer is growing very slowly, it may be watched and treated only if it starts to cause problems.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Leeman JE, Katabi N, Wong, RJ, Lee NY, Romesser PB. Chapter 65 - Cancer of the Head and Neck. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Mendenhall WM, Dziegielewski PT, Pfister DG. Chapter 45- Cancer of the Head and Neck. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Salivary Gland Cancer: Treatment. 2019. Accessed at https://www.cancer.gov/types/head-and-neck/patient/adult/salivary-gland-treatment-pdq on April 25, 2021.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V.2.2021 – March 26, 2021. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on April 25, 2021.

 

References

Leeman JE, Katabi N, Wong, RJ, Lee NY, Romesser PB. Chapter 65 - Cancer of the Head and Neck. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Mendenhall WM, Dziegielewski PT, Pfister DG. Chapter 45- Cancer of the Head and Neck. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Salivary Gland Cancer: Treatment. 2019. Accessed at https://www.cancer.gov/types/head-and-neck/patient/adult/salivary-gland-treatment-pdq on April 25, 2021.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V.2.2021 – March 26, 2021. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on April 25, 2021.

 

Last Revised: March 18, 2022

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