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.