The Farber Center: For Radiation Oncology

Salivary gland cancer is a cancer that starts in one of the salivary glands. It is not a single disease. There are actually several different salivary glands found inside and near your mouth. Several types of cancer and benign (non-cancerous) tumors can develop in these glands.

Most common: painless mass in front or just below earlobe (parotid tumor) or just beneath mandible (submandibular or sublingual tumor):

• Pain
• Facial nerve palsy, or other cranial nerve palsies
• Lower lip anesthesia (don’t feel lower lip)
• Difficulty opening/closing jaw
• Difficulty swallowing
• Painful swallowing

Physical exam and history: An exam of the body to check general signs of health. The head, neck, mouth, and throat will be checked for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat, and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.

Fine needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle. A pathologist views the tissue or fluid under a microscope to look for cancer cells.

T indicates the size of the main (primary) tumor and which, if any, tissues of salivary glands it has spread to.

T0: No evidence of a primary tumor.

T1: Tumor is 2 cm (about ¾ inch) across or smaller. It is not growing into nearby tissues.

T2: Tumor is larger than 2 cm but no larger than 4 cm (about 1½ inch) across. It is not growing into nearby tissues.

T3: Tumor is larger than 4 cm across and/or is growing into nearby soft tissues.

T4a: Tumor is any size and is growing into nearby structures such as the jaw bone, skin, ear canal, and/or facial nerve. This is known as moderately advanced disease.

T4b: Tumor is any size and is growing into nearby structures such as the base of the skull or other bones nearby, or it surrounds the carotid artery. This is known as very advanced disease.

N stands for spread to nearby lymph nodes in the neck

N0: There is no evidence of cancer in the regional nodes.

N1: Cancer has spread to a single node on the same side as the primary tumor and the cancer found in the node is 3 cm or smaller.

N2: Describes any of the following conditions:

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor, and is larger than 3 cm, but not larger than 6 cm.
N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.
N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in the lymph nodes is larger than 6 cm.

M is for metastasis (spread to distant organs).

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage Grouping

Stage 0
Tis, N0, M0

Stage I
T1, N0, M0

Stage II
T2, N0, M0

Stage III
T3, N0, M0, OR T1 to T3, N1, M0

Stage IVA
T4a, N0 or N1, M0, OR T1 to T4a, N2, M0

Stage IVB
T4b, Any N, M0, OR Any T, N3, M0

Stage IVC
Any T, Any N, M1

Clinically/radiographically
Benign appearing or early stage cancer

Complete surgical removal
After surgery: observation or radiation therapy depending on the kind of tumor/cancer

Locally advanced cancer

Surgery preferable upfront. May need radiation therapy afterward
May require post-operative radiation with or without chemotherapy
If surgery not an option, could do radiation therapy with or without chemotherapy

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.