Salivary Gland Tumors

What is Salivary Gland Tumors?

Salivary gland tumors are abnormal growths of cells that form in the salivary glands, the glands that make saliva (spit). Saliva keeps the mouth moist, helps you swallow and start digesting food, and protects the teeth from decay. Most saliva is produced by three pairs of major salivary glands: the parotid glands, which sit in front of and just below each ear; the submandibular glands, which lie under the jaw; and the sublingual glands, which are under the tongue. Hundreds of much smaller minor salivary glands are scattered across the lining of the lips, cheeks, palate (roof of the mouth), and throat.

A tumor can be benign (not cancer) or malignant (cancer). Benign salivary gland tumors do not spread to other parts of the body, although some can keep growing and may return after removal. Malignant salivary gland tumors, also called salivary gland cancer, can invade nearby tissue and, in some cases, spread to lymph nodes or distant organs. In general, the majority of salivary gland tumors are benign, and most arise in the parotid gland. Tumors that begin in the smaller glands are less common but are more likely to be malignant.

Salivary gland tumors can occur at any age, but they are diagnosed most often in adults, and cancerous forms are more common in older adults. They affect both men and women. These conditions are usually managed by specialists in ear, nose, and throat medicine, sometimes together with head and neck surgeons, oncologists (cancer doctors), and radiation specialists. At Acibadem, this care is coordinated through the Otorhinolaryngology (ENT) department.

Symptoms of salivary gland tumors

Many salivary gland tumors are first noticed as a painless lump. Because the parotid gland lies just in front of the ear and over the angle of the jaw, a swelling there is the most common presentation. Common salivary gland tumors symptoms include:

• A lump or swelling in the cheek, in front of the ear, under the jaw, or inside the mouth
• A lump that slowly grows over months or years
• Numbness or tingling in part of the face
• Weakness or drooping on one side of the face
• Persistent pain in the face, jaw, mouth, or neck
• Difficulty opening the mouth wide (trismus)
• Trouble swallowing
• Fluid or blood draining from the ear on one side
• Swollen lymph nodes in the neck

The pattern of symptoms often depends on whether the tumor is benign or malignant. Benign tumors are typically slow-growing, soft or rubbery, movable under the skin, and painless. Malignant tumors may grow more quickly, feel hard or fixed to surrounding tissue, and are more likely to cause pain. A particularly important sign is facial weakness. The facial nerve, which controls the muscles of facial expression, runs directly through the parotid gland. A benign tumor rarely damages this nerve, so new facial weakness alongside a parotid lump raises concern for cancer and needs prompt assessment.

Tumors in the minor salivary glands may appear as a painless bump on the palate, inside the lip, or in the cheek. Because these can look like a harmless cyst or sore, they are sometimes overlooked. In later stages, a malignant tumor may cause ulceration of the overlying skin or mouth lining, more widespread pain, or noticeable neck swelling from lymph node involvement. It is worth remembering that many lumps in these areas are not tumors at all; infections, stones in the salivary ducts, and enlarged lymph nodes can cause similar swelling. Only a medical evaluation can tell the difference.

Causes and risk factors

In most people, the exact salivary gland tumors causes are not known. A tumor develops when cells in the gland acquire changes in their DNA that make them grow and divide when they should not. Why these changes happen in a particular person is usually unclear. Researchers have, however, identified several factors that appear to raise the chance of developing a salivary gland tumor:

• Older age: the risk of malignant tumors rises with age, although benign tumors can occur in younger adults as well.
• Previous radiation exposure: radiation therapy to the head or neck for another condition, especially in childhood, is a recognized risk factor. Historical medical treatments and environmental radiation exposure have also been linked to these tumors.
• Occupational exposures: long-term contact with certain substances used in rubber manufacturing, asbestos mining, plumbing, and some types of woodworking has been associated with a higher risk in some studies.
• Tobacco and alcohol: smoking is linked with one specific benign parotid tumor (Warthin tumor). The link between smoking or heavy alcohol use and salivary gland cancer is weaker than for other head and neck cancers, but avoiding both is still advisable.
• Viral infections: some viruses, including Epstein-Barr virus, have been associated with certain rare salivary cancers, particularly in specific populations.
• Family history and inherited conditions: rarely, salivary gland tumors run in families or occur as part of an inherited syndrome.

Having one or more of these risk factors does not mean you will develop a tumor, and many people who are diagnosed have no identifiable risk factor at all.

Diagnosis of salivary gland tumors

Salivary gland tumors diagnosis starts with a medical history and a physical examination. Your doctor will ask how long the lump has been present, whether it has changed in size, and whether you have pain, numbness, or facial weakness. They will feel the lump, examine the inside of your mouth and throat, check the movement of your facial muscles, and feel the neck for enlarged lymph nodes.

Because a physical examination cannot reliably tell a benign tumor from a malignant one, further tests are usually needed:

• Ultrasound: a painless scan using sound waves that shows the size and structure of the lump and can guide a needle biopsy. It is often the first imaging test.
• Fine-needle aspiration (FNA) biopsy: a thin needle is passed into the lump to draw out a small sample of cells, which a pathologist (a doctor who studies tissue under a microscope) examines. FNA is the most common way to find out what type of tumor is present before surgery, although the result is not always definitive.
• Core needle biopsy: a slightly larger needle removes a small cylinder of tissue when FNA does not give a clear answer.
• MRI (magnetic resonance imaging): uses magnets and radio waves to create detailed pictures of soft tissue. It is very helpful for showing how deep a tumor extends and its relationship to the facial nerve.
• CT (computed tomography) scan: a series of X-ray images that can show involvement of bone and lymph nodes.
• PET-CT scan: sometimes used when cancer is confirmed, to look for spread to other parts of the body.

Doctors generally do not perform an open surgical biopsy of a parotid lump, because cutting into the tumor can spread cells and increase the chance of recurrence. Instead, if a tumor needs to be removed, the entire tumor is taken out and then examined. The final diagnosis is made by the pathologist. If cancer is found, it is given a type (there are more than twenty kinds), a grade (low, intermediate, or high, reflecting how aggressive the cells look), and a stage (describing size and spread). These details guide salivary gland tumors treatment planning.

Treatment options for salivary gland tumors

Treatment depends on whether the tumor is benign or malignant, its type and grade, its size and location, and your general health. In most cases, the main treatment is surgery.

Observation. Watchful waiting is rarely recommended for a confirmed salivary gland tumor, because even benign tumors tend to grow and some can turn cancerous over many years. However, in an older or frail person with a small, clearly benign tumor, your doctor may suggest monitoring with regular examinations and scans rather than immediate surgery.

Surgery. Removing the tumor is the standard treatment for both benign and malignant salivary gland tumors. For parotid tumors, the operation is called a parotidectomy. In a superficial parotidectomy, the part of the gland lying outside the facial nerve is removed along with the tumor. In a total parotidectomy, the whole gland is removed. Whenever possible, the surgeon identifies and preserves the facial nerve, often using a nerve monitor during the operation. If a cancer has grown into the nerve, part of it may need to be removed, and the surgeon may reconstruct it with a nerve graft. Submandibular gland tumors are treated by removing the whole gland. Minor salivary gland tumors are removed together with a margin of surrounding healthy tissue. If cancer has spread to lymph nodes, or if there is a significant risk that it has, the surgeon may remove lymph nodes from the neck in a procedure called a neck dissection.

Radiation therapy. Radiation uses high-energy beams to destroy cancer cells. It is commonly given after surgery for malignant tumors that are high grade, large, close to or involving the surgical margins, or that have spread to lymph nodes or nerves. Radiation may also be used as the main treatment when a tumor cannot be removed safely or when a person is not well enough for surgery. Treatment is usually delivered in daily sessions over several weeks. Side effects can include dry mouth, skin irritation, taste changes, and fatigue; your care team will discuss how to manage these.

Medication. Chemotherapy (drugs that kill rapidly dividing cells) is not usually a first-line treatment for salivary gland cancer, but it may be used for cancer that has spread or returned, sometimes combined with radiation. Targeted therapies and immunotherapy are options for some specific tumor types in selected situations, and your oncologist may discuss whether a clinical trial is appropriate. Benign tumors are not treated with medication.

Rehabilitation and follow-up. After surgery, some people experience temporary weakness of the facial muscles, numbness of the earlobe, or a hollow in the cheek. Physical therapy for the face can help recovery of movement. A condition called Frey syndrome, in which the cheek sweats and flushes while eating, can develop months after parotid surgery and can be treated if it becomes bothersome. Speech and swallowing therapists may help if the mouth or throat were involved. Regular follow-up visits with examinations and, when appropriate, imaging are important for years afterward, because some tumors can recur late.

Living with salivary gland tumors and outlook

For benign tumors that are completely removed, the outlook is generally very good, and most people return to normal activities within a few weeks. The most common benign tumor, the pleomorphic adenoma, can come back if any tissue is left behind, which is why complete removal and ongoing follow-up matter.

The outlook for salivary gland cancer varies widely. It depends heavily on the specific tumor type and grade, the stage at diagnosis, whether the facial nerve or lymph nodes are involved, and whether the tumor could be fully removed. Low-grade cancers found early are often treated successfully with surgery alone. High-grade cancers and those diagnosed at a later stage are more challenging, and some types, such as adenoid cystic carcinoma, can recur many years after treatment, so long-term surveillance is needed. Your care team can give you a more individual picture based on your pathology report and staging.

Day to day, many people adjust well after treatment. Dry mouth after radiation can be eased by sipping water frequently, using saliva substitutes, and keeping up careful dental care, since reduced saliva increases the risk of tooth decay. Facial changes, even mild ones, can affect confidence, and talking with a counselor or a support group can help. Keeping follow-up appointments and reporting any new lump, pain, or facial weakness promptly gives the best chance of catching a recurrence early.

Frequently asked questions

Are most salivary gland tumors cancerous?

No. Most salivary gland tumors are benign, particularly those in the parotid gland. The likelihood of a tumor being malignant is higher when it arises in the submandibular, sublingual, or minor salivary glands, and when it causes pain, rapid growth, or facial weakness. Only a biopsy and, usually, examination of the removed tumor can confirm whether it is cancer.

What are the first symptoms of salivary gland tumors?

The most common first symptom is a painless lump in front of the ear, below the jaw, or inside the mouth that slowly enlarges. Some people notice it while shaving or washing their face. Pain, numbness, and facial weakness tend to appear later or with malignant tumors, so a lump should be checked even when it does not hurt.

What causes salivary gland tumors?

In most cases the cause is unknown. Recognized salivary gland tumors causes and risk factors include previous radiation exposure to the head and neck, older age, certain workplace chemical exposures, and, for one benign tumor type, smoking. Most people diagnosed have no clear risk factor.

How is salivary gland tumors diagnosis confirmed?

Doctors usually combine a physical examination with ultrasound or MRI and a fine-needle aspiration biopsy. The needle biopsy gives an initial idea of the tumor type, but the final diagnosis, including grade and stage for cancers, is made by a pathologist after the tumor has been surgically removed.

Is surgery always needed for salivary gland tumors treatment?

Surgery is the standard treatment for the great majority of salivary gland tumors, benign or malignant, because they tend to keep growing and a benign tumor can occasionally become cancerous. In some situations, such as a very small tumor in a person who is not fit for an operation, your doctor may recommend monitoring or radiation instead.

Will I have facial paralysis after parotid surgery?

Permanent facial paralysis is uncommon when a benign tumor is removed, because the surgeon works carefully to preserve the facial nerve. Temporary weakness that improves over weeks to months is more common. If a cancer has invaded the nerve, part of it may need to be removed, and your surgeon will discuss reconstruction options with you beforehand.

Can salivary gland tumors come back after treatment?

Yes, some can. Certain benign tumors may recur if any tissue is left behind, and several types of salivary gland cancer can return years after treatment. This is why long-term follow-up with regular examinations and, when needed, imaging is recommended.

When to see a doctor

Any new lump in the face, mouth, or neck that lasts more than two to three weeks should be assessed by a doctor, even if it is painless. Seek medical attention promptly, rather than waiting, if you notice any of the following red-flag signs:

• A lump in front of the ear, under the jaw, or in the mouth that is growing quickly
• New weakness, drooping, or paralysis of one side of the face
• Numbness or persistent pain in the face, jaw, or mouth
• A lump that feels hard or is fixed and does not move under the skin
• Difficulty opening the mouth, swallowing, or speaking
• An ulcer or sore over the lump, or bleeding from the mouth or ear
• Swollen glands in the neck that do not settle
• Unexplained weight loss together with any of the above

Many of these signs have other, less serious explanations, but they can also indicate a malignant tumor that benefits from early treatment. Evaluation is usually carried out by an ear, nose, and throat specialist, who can arrange the imaging and biopsy needed to reach a diagnosis.