Treatment Options by Stage of Salivary Gland Cancer

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

Stage I

These cancers are small and still within 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 may 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, or if the edges of the removed area contain cancer cells (a sign that some cancer may have been left behind).

Stage II

Stage II salivary gland cancers are larger but are still confined within 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.

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, or if the edges of the removed specimen contain cancer cells. There is a greater chance that some cancer may have been left behind than with stage I cancers.

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

These cancers are even larger and/or have started to grow outside the salivary gland. They might have also reached lymph nodes in the neck.

Doctors generally recommend extensive surgery (removing the salivary gland containing the tumor, nearby tissues, and all 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 many cases, especially for high-grade tumors, surgery is 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).

Stage IV

Stage IV 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. It's used to try to shrink the tumor(s) and relieve pain, bleeding, or other symptoms. Radiation may be combined with chemo. If the cancer has spread to other parts of the body, chemo may shrink or slow the growth of the cancer for a time and may help relieve symptoms.

Because these cancers can be hard to treat, taking part in a clinical trial of newer treatments is a good option.

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.

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.

Last Revised: September 28, 2017

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