Salivary Gland Tumours
Parotid tumour · Submandibular gland tumour · Pleomorphic adenoma · Warthin tumour | ICD-O-3 C07–C08
Salivary gland tumours are a diverse group of benign and malignant growths in the parotid, submandibular, sublingual and minor salivary glands. They are rare worldwide, with comparatively higher relative rates in parts of Western and Central Africa. Most parotid tumours are benign, but facial nerve weakness, rapid growth or pain suggest malignancy and require specialist surgery.
Roughly four in five salivary gland tumours arise in the parotid gland in front of the ear, and the majority of those are benign — pleomorphic adenoma and Warthin tumour being the commonest. Tumours of the submandibular and minor salivary glands (for example on the palate) have a higher probability of being malignant, so site is an important part of the assessment.
Salivary gland cancers are unusual among head and neck tumours because histology drives management more than size. Adenoid cystic carcinoma, for instance, grows slowly but tracks along nerves and can recur many years later; mucoepidermoid and salivary duct carcinomas behave quite differently. A core biopsy or expert FNA review is therefore valuable before planning the operation.
Where in the world is salivary gland tumours common?
about 55,100 new salivary gland cancer cases worldwide were estimated worldwide in 2022 (male ASR 0.7 and female ASR 0.5 per 100,000; 7.3% of all lip/oral/pharyngeal cancers in 2022).
GLOBOCAN 2022 reported 55,083 cases with an ASR of 0.56 per 100,000. Benign tumours are far more common but are not counted in cancer registries.
| Region / country | What the data show |
|---|---|
| Western Africa | Salivary gland cancers represent 21.8% of the region’s lip/oral/pharyngeal cancer burden — the highest relative share worldwide — with Burkina Faso reporting the highest female ASR (1.2/100,000). |
| Central Africa | 16.1% of the regional lip/oral/pharyngeal burden; salivary gland cancer is the most common subsite in men in Benin, Chad and Togo in the 2022 analysis. |
| Haiti & the Caribbean | Haiti reported one of the highest male ASRs (1.9/100,000) in the subsite analysis, illustrating small-population variation. |
| South-Central Asia | Among the lowest relative shares (4.0%), because oral cavity cancer dominates the regional burden. |
| Europe & North America | Low absolute rates but well-characterised histology; prior radiotherapy, smoking (Warthin tumour) and autoimmune disease are recognised associations. |
What are the risk factors?
- Previous ionising radiation to the head and neck (including childhood radiotherapy)
- Cigarette smoking — strongly associated with Warthin tumour
- Sjögren syndrome and other autoimmune disease (lymphoma / MALT)
- Occupational exposure to nickel compounds, silica, wood or leather dust in some studies
- Prior benign pleomorphic adenoma, which can rarely transform into carcinoma ex pleomorphic adenoma
- Viral associations in specific subtypes (e.g. EBV in lymphoepithelial carcinoma in endemic populations)
What are the signs and symptoms?
- A painless, slowly growing lump in front of or below the ear (parotid) or under the jaw
- Weakness or asymmetry of facial movement — a warning sign for malignant invasion
- Rapid growth, pain, skin fixation, ulceration or numbness
- A swelling on the palate, inside the cheek or on the upper lip (minor salivary glands)
- Difficulty opening the mouth or swallowing with deep-lobe tumours
- Hard lumps in the neck from nodal spread in high-grade cancers
Two-to-three-week rule: any head or neck symptom that persists beyond two to three weeks should be examined by an ENT specialist with an endoscope — pain is usually a late feature, not an early one.
How is it diagnosed and staged?
- Clinical examination including facial nerve function and bimanual palpation of the oral cavity
- High-resolution ultrasound plus contrast MRI (best for deep-lobe, perineural and skull-base extension) or CT when bone detail is needed
- Ultrasound-guided core-needle biopsy or FNA reported by a head and neck cytopathologist
- Assessment of facial nerve involvement, skin/ bone fixation and cervical nodes
- Chest imaging and PET-CT for high-grade or advanced malignant histology
- Multidisciplinary review, because the operation differs markedly between benign and malignant pathology
AJCC TNM staging for major salivary gland cancers uses tumour size, extraparenchymal extension, facial nerve involvement, nodal metastases and distant metastasis. Unlike squamous cell carcinoma of the oral cavity, grade and histological subtype are often more important for adjuvant treatment decisions than T category alone.
What are the treatment options?
- Superficial or total parotidectomy with identification and preservation of the facial nerve for benign and low-grade tumours
- Excision of submandibular or minor gland tumours with appropriate margins; avoid simple "shelling out" of a pleomorphic adenoma because of recurrence risk
- Neck dissection for high-grade, node-positive or advanced malignant tumours
- Adjuvant radiotherapy for high grade, positive margins, perineural invasion, nodal disease or adenoid cystic carcinoma; neutron/proton therapy in selected centres
- Systemic therapy, targeted therapy or clinical trials for unresectable, recurrent or metastatic disease
- Observation of small asymptomatic Warthin tumours in older or high-risk patients may be reasonable
Decisions should be made by a multidisciplinary tumour board, with speech, swallowing and appearance considered alongside cancer control. See how treatment changes with stage →
What is the prognosis?
Benign pleomorphic adenoma has excellent outcomes after complete excision. Low-grade malignant tumours often have five-year survival above 80%, while high-grade tumours, salivary duct carcinoma and node-positive disease do considerably worse. Adenoid cystic carcinoma is notable for late local recurrence and distant metastasis, so follow-up extends beyond five years; facial nerve function and chronic recurrence are the main quality-of-life issues.
Survival figures are population averages from registry data, not predictions for an individual. See the follow-up schedule →
Can it be prevented?
- Avoid unnecessary head and neck radiation, especially in children
- Stop smoking — relevant to Warthin tumour and overall head and neck cancer risk
- Use respiratory protection in dust- and nickel-exposed occupations
- Have any persistent parotid or submandibular lump imaged and sampled rather than observed indefinitely
- Long-term follow-up after pleomorphic adenoma to detect rare malignant transformation
Prevention by region: HPV vaccine, areca nut, tobacco and UV →
Treatment in China for international patients
Parotid and submandibular surgery is a standard part of Chinese ENT/head and neck practice, with intraoperative facial nerve monitoring and immediate reconstruction available in tertiary centres. For international patients, a key question is whether a benign tumour can be removed with minimal dissection and preserved nerve function.
- Bring ultrasound/MRI images on DICOM and the FNA or core biopsy report and slides; histology changes the operation substantially.
- Ask whether facial nerve monitoring is used, what the expected temporary weakness rate is, and how the nerve would be managed if it is involved.
- Request written pathology including margin status, grade, perineural invasion and lymphovascular invasion.
- For adenoid cystic carcinoma, ask about the long-term surveillance plan, since late recurrence is characteristic.
Cost guidance: As an illustrative planning range, parotidectomy for a benign tumour is commonly budgeted at ¥25,000–¥60,000 (about US$3,500–8,400); malignant tumour surgery with neck dissection and adjuvant radiotherapy ¥70,000–¥170,000. These are budgeting figures, not a quotation.
Compare the pathway, records checklist and aftercare planning on the international patients page.
All 14 questions about salivary gland tumours
Each question has its own page with a direct answer, practical detail and the sources behind it — the same structure used on Dr. Liu’s Chinese knowledge base.
Understanding the disease
4 questionsWhat the tumour is, where in the world it is common, who gets it and why.
Symptoms & diagnosis
2 questionsThe warning signs, the biopsy, the scans and what staging actually means.
Treatment
3 questionsSurgery, radiotherapy, chemotherapy, immunotherapy and organ-preserving options.
Prognosis & follow-up
2 questionsSurvival figures in context, recurrence risk and the follow-up schedule.
Prevention & risk
2 questionsHPV vaccination, tobacco and areca nut, UV protection and occupational exposure.
Treatment in China
1 questionWhat international patients should prepare, timelines, costs and aftercare.
Frequently asked questions
What is salivary gland tumours?
Salivary gland tumours are a diverse group of benign and malignant growths in the parotid, submandibular, sublingual and minor salivary glands. They are rare worldwide, with comparatively higher relative rates in parts of Western and Central Africa. Most parotid tumours are benign, but facial nerve weakness, rapid growth or pain suggest malignancy and require specialist surgery.
Where in the world is salivary gland tumours most common?
Salivary Gland Tumours is not evenly distributed: the highest-burden regions are Western Africa, Central Africa and Haiti & the Caribbean. In 2022 there were about 55,100 new salivary gland cancer cases worldwide worldwide (male ASR 0.7 and female ASR 0.5 per 100,000; 7.3% of all lip/oral/pharyngeal cancers in 2022), with marked country-to-country variation driven by local exposures such as tobacco, areca nut, oncogenic viruses, ultraviolet radiation and occupational carcinogens.
What are the risk factors for salivary gland tumours?
The main recognised risk factors for salivary gland tumours are previous ionising radiation to the head and neck (including childhood radiotherapy), cigarette smoking — strongly associated with Warthin tumour and sjögren syndrome and other autoimmune disease (lymphoma / MALT). Risks differ by region: Western Africa has a distinctive exposure pattern, so a patient's country of residence is part of the risk assessment. Having a risk factor does not mean a person will develop cancer.
What are the early signs of salivary gland tumours?
The common early signs are a painless, slowly growing lump in front of or below the ear (parotid) or under the jaw, weakness or asymmetry of facial movement — a warning sign for malignant invasion, rapid growth, pain, skin fixation, ulceration or numbness and a swelling on the palate, inside the cheek or on the upper lip (minor salivary glands). Head and neck tumours often cause mild, one-sided symptoms that mimic a cold, a dental problem or a sore throat. Any symptom in the head or neck that persists for more than two to three weeks needs an ENT examination rather than repeated antibiotics.
How is salivary gland tumours diagnosed and staged?
Diagnosis requires a tissue biopsy read by a head and neck pathologist, supported by endoscopic examination and contrast CT or MRI of the neck; PET-CT is added when nodal or distant spread is suspected. Staging uses the AJCC TNM system and guides whether surgery, radiotherapy, chemoradiotherapy or systemic therapy is the primary treatment.
What are the treatment options for salivary gland tumours?
Treatment is stage- and site-specific, and usually combines superficial or total parotidectomy with identification and preservation of the facial nerve for benign and low-grade tumours, excision of submandibular or minor gland tumours with appropriate margins; avoid simple "shelling out" of a pleomorphic adenoma because of recurrence risk and neck dissection for high-grade, node-positive or advanced malignant tumours. Early-stage disease is generally treated with one modality (surgery or radiotherapy), while locally advanced disease needs combined modality treatment planned by a multidisciplinary team.
What is the prognosis for salivary gland tumours?
Benign pleomorphic adenoma has excellent outcomes after complete excision. Low-grade malignant tumours often have five-year survival above 80%, while high-grade tumours, salivary duct carcinoma and node-positive disease do considerably worse. Adenoid cystic carcinoma is notable for late local recurrence and distant metastasis, so follow-up extends beyond five years; facial nerve function and chronic recurrence are the main quality-of-life issues.
Can salivary gland tumours be prevented?
Many cases are preventable. The most useful steps for salivary gland tumours are avoid unnecessary head and neck radiation, especially in children, stop smoking — relevant to Warthin tumour and overall head and neck cancer risk and use respiratory protection in dust- and nickel-exposed occupations. Prevention works best before exposure begins, but stopping tobacco, areca nut and heavy alcohol use still lowers risk after many years of use.
Is a parotid lump usually cancer?
No. Most parotid gland tumours are benign, particularly pleomorphic adenoma and Warthin tumour. Features that raise concern are rapid growth, pain, facial nerve weakness, hard fixation to skin or deep tissue, numbness and neck nodes. Tumours in the submandibular or minor salivary glands have a higher chance of being malignant.
Will surgery damage the facial nerve?
For benign and most low-grade tumours, the facial nerve is identified and preserved, often with intraoperative nerve monitoring. Temporary weakness of part of the face is not uncommon from nerve manipulation and usually recovers over weeks to months. The nerve is sacrificed only when it is directly invaded by cancer and cannot be separated, in which case reconstruction may be planned.
Why can’t a benign parotid lump simply be "shelled out"?
Pleomorphic adenomas have microscopic extensions beyond their capsule and a thin, incomplete pseudocapsule. Simply enucleating the lump leaves tumour cells behind and risks multifocal recurrence that is much harder to remove later, often with greater risk to the facial nerve. Formal superficial or total parotidectomy with nerve preservation is the standard.
Why does adenoid cystic carcinoma need such long follow-up?
Adenoid cystic carcinoma has a characteristic pattern of slow growth, perineural spread and late local recurrence or lung metastasis — sometimes five, ten or more years after apparently successful treatment. Short-term survival can look excellent even when long-term control is uncertain.
Why do salivary gland cancers make up a larger share of head and neck cancer in parts of Africa?
The 2022 subsite analysis found the highest relative shares in Western Africa (21.8%) and Central Africa (16.1%), with high male ASRs in Haiti and Togo. These figures mostly reflect the comparatively low rates of other lip/oral/pharyngeal subsites in those regions plus registry and diagnostic variation, rather than a proven single environmental cause.
What does salivary gland surgery cost in China for international patients?
Illustrative planning ranges are ¥25,000–¥60,000 (about US$3,500–8,400) for parotidectomy for a benign tumour and ¥70,000–¥170,000 for malignant tumour surgery with neck dissection and adjuvant radiotherapy. These are budgeting figures, not a quotation.
Sources for this topic
- Global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2022
- Global Cancer Observatory (GLOBOCAN 2022)
- Nivolumab Risk Management Plan — epidemiological characteristics of SCCHN (GLOBOCAN 2022 summary)
- NCCN Guidelines for Patients: Head and Neck Cancers
- Head and Neck Cancers (patient information)
Ask about salivary gland tumours treatment in China
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What to send Contact the clinicMedical disclaimer: This knowledge base is general information for people researching head and neck tumours, not a diagnosis or treatment plan. It does not replace an examination by a qualified physician. Survival figures are population averages, not predictions for an individual. Treatment and cost estimates for China are illustrative only and must be confirmed in writing after your records have been reviewed. If you have a symptom lasting more than two to three weeks, see a doctor promptly.