Salivary gland cancer

The most common. Low-grade ones are usually cured with surgery; high-grade ones need more treatment.

Grows slowly but spreads along nerves, and can spread to the lungs many years later. Long follow-up is needed.

Aggressive. Often has androgen receptor or HER2 on the cells, which can be targeted.

Acinic cell carcinoma (usually slow growing), and others.

Ultrasound with a fine needle sample (FNAC) or core biopsy. An open biopsy of the parotid is avoided.

MRI shows the tumour and nerve involvement; CT or PET-CT checks the neck and lungs.

In advanced cancer: androgen receptor, HER2 and NTRK on the tumour, which can be treated with specific medicines.

A dental check before radiotherapy, and a dietitian review. Many patients have lost weight; a feeding tube may be advised before treatment.

Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.

Before immunotherapy, also:

Sometimes needed, depending on your treatment:

• Pregnancy test for women who could be pregnant.
• Calcium and magnesium: for example before cisplatin or bone-strengthening injections.
• Dental check-up before bone-strengthening injections (zoledronic acid or denosumab), as they can rarely affect the jaw bone.
• Hearing test before cisplatin, in some patients.
• Clotting tests (PT/INR) before a biopsy or chemoport.

Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.

• The type and grade decide whether the neck nodes are removed and whether radiotherapy is needed.
• Surgery is planned to protect the facial nerve where possible.

Tumour up to 4 cm, within the gland, no nodes. Usually curable with surgery.

Larger tumour, growing into skin, bone or the facial nerve, or neck nodes involved.

Spread to the lungs, bones or elsewhere.

1. Surgery: removal of the gland (parotidectomy), protecting the facial nerve.
2. Radiotherapy afterwards for high-grade tumours or close margins.

Side effects: surgery

1. Surgery with neck dissection; the facial nerve is removed only if the cancer involves it (with nerve grafting where possible).
2. Radiotherapy afterwards, sometimes with chemotherapy.

Side effects: surgery · radiotherapy

1. Slow-growing spread (such as adenoid cystic) may be watched without treatment for a long time.
2. Targeted by markers: hormone treatment for androgen receptor positive; trastuzumab-based treatment for HER2 positive; larotrectinib for NTRK.
3. Chemotherapy for others.

Side effects: chemotherapy

• Temporary facial weakness is common after parotid surgery and usually recovers over weeks to months.
• Frey's syndrome: sweating or flushing of the cheek while eating; treatable.
• Numbness of the ear lobe.

• From the 2nd or 3rd week: sore mouth and throat (mucositis), painful swallowing, thick saliva and loss of taste. Pain medicines, mouthwashes and soft food help; a feeding tube is used if eating becomes difficult.
• Skin redness on the neck, like sunburn.
• Weight loss: a dietitian review is important.
• Long-term: dry mouth, tooth decay, stiffness of the jaw, neck stiffness, and an underactive thyroid (check TSH yearly).
• Most early side effects settle 4 to 8 weeks after treatment.

• Nausea and vomiting: well controlled with medicines given before and after chemotherapy.
• Low blood counts and infection risk: fever of 38°C or more needs urgent care.
• Tiredness, mouth sores, loose stools or constipation.
• Cisplatin: nausea, kidney effects, ringing in the ears or hearing loss; plenty of fluids are given.

More about chemotherapy · Side effects of your regimen

• The immune system can affect normal organs: thyroid, skin (rash, itching), bowel (loose stools), lungs (cough, breathlessness) and liver.
• These can happen months after starting, or even after stopping. Report any new symptom, even if it seems small.
• Thyroid, cortisol and liver blood tests are checked regularly.

More about immunotherapy · Side effects of your regimen

• Dental check-up before radiotherapy; unhealthy teeth may need removal first.
• After radiotherapy: soft toothbrush, fluoride toothpaste or gel daily, and regular dental visits for life.
• Tell any dentist you had radiotherapy before a tooth extraction: the jaw bone heals poorly (risk of osteoradionecrosis).
• Mouth-opening and jaw exercises every day help prevent stiffness.

• Soft, moist, high-protein food and nutritional supplements during treatment.
• Keep swallowing small sips or soft food even with a feeding tube, so the swallowing muscles stay active.
• Speech and swallowing therapy helps recovery. Nutrition and diet

• Stop all tobacco (smoking, gutka, khaini, betel quid) and alcohol completely.
• Continuing tobacco makes treatment less effective, increases side effects, and greatly increases the risk of a second cancer.
• Ask us for help; medicines and counselling make quitting easier.

• Every 1 to 3 months in the first year, then less often, for at least 5 years.
• A PET-CT or MRI about 3 months after treatment to check the response.
• Thyroid test (TSH) every year after neck radiotherapy.
• Mind and emotions

Bleeding from the mouth, throat or neck, difficulty breathing or noisy breathing, inability to swallow even liquids, or fever of 38°C or more need urgent care.

When to seek help urgently