Salivary Gland Cancer Treatment

Treatment plans for salivary gland cancer can change drastically based on the tumor’s exact location and subtype. Just a few millimeters can make a huge difference. The right treatment plan can greatly reduce the chance of the cancer returning and help maintain your quality of life, including your ability to speak, swallow and hear.

At MD Anderson you will get care from a team of salivary gland cancer experts, including a surgeon, radiation oncologist and medical oncologist. All specialize in treating salivary gland cancer, giving them incredible expertise to call on when planning your care. They will work together closely to discuss your case and develop a treatment plan tailored to you. 

Treatments can include many cutting-edge interventions, such as proton therapy, targeted therapy and advanced robotic surgeries.

Surgery

Surgery is the primary treatment for most salivary gland cancers. Most procedures require incisions in the skin to access the tumor. Depending on the tumor’s location, a few can be performed with an endoscope. This is a thin, flexible tube can be inserted through the mouth to the tumor’s location. Doctors use tools at the end of the tube to remove the tumor.

Parotid gland surgery

There are two main types of parotid gland surgery. The type of surgery a patient gets depends on whether the tumor is only in the gland’s superficial lobe or if it started in or has moved into the deep lobe.

• Superficial parotidectomy: During this procedure, doctors remove the tumor and a small amount of healthy tissue. This is used for tumors that form in the superficial lobe and have not spread deeply into deep lobe.
• Total parotidectomy: This surgery is for tumors that started or have spread into the deep lobe, which makes up the interior of the gland. The entire parotid gland is removed during this procedure.

The facial nerve, which controls facial movement, runs through the parotid gland and divides the superficial lobe from the deep lobe. The goal of all parotid gland surgeries is to remove the tumor and preserve the function of the facial nerve.

In addition, cancers of the parotid gland can spread into the skull base and grow along facial nerves. In these cases, the procedure may require surgeons from several areas, including head and neck surgery, skull base surgery and neurosurgery. Learn more about skull base tumors.

Sublingual and submandibular gland surgery

Surgery on the sublingual or submandibular glands usually removes the entire gland and possibly nearby tissue. Nearby nerves that control the tongue and parts of the face and taste may also be affected.

Minor salivary gland surgery

Surgery for this cancer depends on the tumor’s exact location. A small section of healthy tissue surrounding the tumor may be removed during the procedure.

Reconstructive surgery

Most salivary gland surgery does not require any special reconstruction. In rare cases, the surgery might impact a patient’s appearance and ability to chew and swallow. These issues are addressed in each patient’s care plan. If the patient needs reconstructive surgery, that procedure usually takes place at the same time as the surgery to remove the tumor.

Radiation therapy

Radiation therapy uses powerful, focused beams of electromagnetic energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.

Learn more about radiation therapy.

For salivary gland cancer, radiation therapy is typically used after surgery to kill any remaining cancer cells. It is also used when surgery isn’t possible.

The types of radiation used to treat salivary gland cancer include:

• Intensity modulated radiation therapy (IMRT), which focuses multiple radiation beams of photons with different intensities directly on the tumor.
• Volumetric modulated arc therapy (VMAT), a newer form of IMRT that utilizes a rotating treatment machine to deliver radiation from multiple angles.
• Proton therapy, which is similar to standard (photon) radiation therapy, but uses a different type of energy, called protons. This may allow doctors to target tumors with much more accuracy. This limits damage to nearby healthy tissue and allows for the delivery of a more powerful dose of radiation. Learn more about proton therapy.
• Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative body radiation (SABR), precisely targets tumors with very high doses of radiation in fewer sessions. SBRT achieves this by using several highly focused radiation beams of various intensities aimed at the tumor from different angles. Learn more about SBRT.

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. 

Chemotherapy is not often used in salivary gland cancer, but it can be used in combination with radiation therapy in select cases. It can also be used for patients with stage IV cancer.

Learn more about chemotherapy.

Targeted therapy

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.

Learn more about targeted therapy.

Immune checkpoint inhibitors 

Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. Immune checkpoint inhibitors are only used in select cases.

Learn more about immune checkpoint inhibitors.

Specialized care for salivary gland cancer patients

Salivary gland cancer and its treatments can impact a person’s ability to eat, drink and speak, as well as their appearance. MD Anderson offers therapies and services to help salivary gland cancer patients adjust to and overcome these challenges as much as possible.

Audiology care: Audiologists at MD Anderson examine patients for the tumor’s impact on hearing and balance and provide care if needed.

Speech therapy: MD Anderson speech pathologists and audiologists offer patients the most advanced techniques for restoring speech after salivary gland cancer and its treatment.

Swallowing therapy: Experts in MD Anderson’s Speech Pathology and Audiology Section are dedicated to evaluating and treating patients who have difficulty eating, drinking and swallowing after treatment. MD Anderson’s  swallowing service is one of the leaders in this field and serves as a model for the management of patients treated for salivary gland cancers. 

Dental care: The teeth and jaw of salivary gland cancer patients can be damaged by the disease and its treatments. MD Anderson dentists specialize in designing implants and performing procedures to help salivary gland cancer patients restore appearance and function. 

Survivorship: MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.

Regular follow-up and screenings are vital due to the high risk of salivary gland returning. Patients need to see their doctors every three to six months for the first two years after treatment, since most cancers that recur, or come back, do so within that time. 

Salivary gland patients are also strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful and worsen side effects during treatment. They can also greatly increase the chance of the cancer returning.