Diagnosing Salivary Gland Cancer

NYU Langone doctors are experts at diagnosing salivary gland cancer, a form of head and neck cancer. The salivary glands produce saliva, which helps break down food in the mouth for swallowing and digestion. Tumors can develop in these glands, and some may be cancerous.

There are three main pairs of salivary glands. The largest are the parotid glands, which are located on the sides of the face in front of the ears. Parotid gland cancer is the most common type of salivary gland cancer. Cancer can also develop in the two submandibular salivary glands, which are located in the upper neck below the jaw, and in the pair of sublingual glands, found under the floor of the mouth, beneath the tongue.

In addition to these main pairs of glands, hundreds of microscopic salivary glands are located throughout the mouth and throat. These are called minor salivary glands.

Some salivary gland cancers can spread into the nerves in the head and neck. They can also spread to area lymph nodes, small, bean-shaped organs that make and store lymphocytes, white blood cells that help fight infection. Lymphocytes travel throughout the body via a network of organs and vessels, called the lymphatic system. Salivary gland cancer can spread to the lymph nodes through this system.

Other salivary gland cancers are indolent, meaning they grow slowly and are not life-threatening.

Symptoms of salivary gland cancer can include a lump near the jaw, in the mouth, or in the neck. People with salivary gland cancer may also experience weakness or numbness on one side of the face, swelling or pain in the salivary glands, and difficulty swallowing.

Although the causes of salivary gland cancer are unknown, older age and radiation exposure to the head and neck may increase a person’s risk of developing this type of cancer. It is also more likely to develop in men than in women.

To help diagnose salivary gland cancer, doctors ask about your symptoms and perform a physical exam of the head and neck. During the exam, they feel for abnormal masses in front of the ears, in the mouth, and in the upper neck.

If a doctor detects a mass, he or she uses sophisticated diagnostic tests to determine if salivary gland cancer is present and whether it is aggressive or indolent.

Fine Needle Aspiration

Doctors may perform a fine needle aspiration in the office if they identify a suspicious salivary gland mass. A lymph node that has become swollen because the cancer has spread may also result in a neck mass.

Using a thin needle, doctors remove a small sample of cells from the mass. They may apply a topical anesthetic before the procedure to minimize any discomfort.

A pathologist examines these cells under a microscope. He or she determines whether the cells are cancerous and the type of tumor.

Incisional Biopsy

An incisional biopsy may be used to remove salivary gland masses that may grow in the small glands of the lips and in the soft palate, which is the fleshy part of the roof of the mouth. These masses are rare. In this procedure, the doctor uses small surgical tools to remove a tissue sample, which is then examined under a microscope.

You are given local anesthesia prior to the procedure.

MRI Scans

After salivary gland cancer is diagnosed, doctors may perform an MRI scan to help determine whether the cancer has spread to the nerves in the head and neck or to the soft tissue of the throat.

Your doctor may inject a special dye into a vein in your arm to enhance the MRI images.

CT Scans

A CT scan uses X-rays and a computer to create two- or three-dimensional, cross-sectional images of the head and neck. It can help doctors determine whether the cancer has spread to nearby bones, such as the jawbone.