Treatments for stage 4 salivary gland cancer

The following are treatment options for stage 4 salivary gland cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Radiation therapy

External radiation therapy is the main treatment for stage 4 salivary gland cancer. It can be used to shrink cancer that is in the salivary gland and lymph nodes in the neck to help reduce symptoms like pain and bleeding. It is also given after surgery when it is used as part of the treatment.

If salivary gland cancer has spread to the bones, lung, or brain, external radiation therapy is sometimes used to treat it. Find out more about bone metastases, lung metastases and brain metastases.

Surgery

Surgery may be offered to some people with stage 4 salivary gland cancer because it generally gives the best chance of completely removing it. To have surgery, the cancer must not have spread to other (distant) organs.

The types of surgery that may be offered depend on where the tumour is found.

Total parotidectomy is done for tumours in a parotid gland.

Sialoadenectomy is done for tumours in the salivary glands in the lower jaw or under the tongue.

Neck dissection is done to remove the lymph nodes in the neck.

  • Selective neck dissection removes only the lymph nodes where the cancer has spread. This includes the lymph nodes close to and on the same side of the neck as the salivary gland tumour.

  • Radical neck dissection removes all of the lymph nodes around and on the same side of the neck as the salivary gland tumour. Other tissues are sometimes removed if the cancer has spread to them.

Reconstructive surgery is usually needed after surgery for stage 4 salivary gland cancer. This may include skin, tissue and nerve grafts.

Chemotherapy

Chemotherapy may be offered for stage 4 salivary gland cancer that has spread to distant organs. It may also be offered to people who do not want to have surgery or radiation therapy.

Salivary gland cancer is most often treated with a combination of drugs. The most common chemotherapy combinations used for stage 4 salivary gland cancer are:

  • cyclophosphamide (Procytox), doxorubicin and cisplatin
  • cisplatin, doxorubicin and fluorouracil
  • cisplatin, epirubicin and fluorouracil
  • vinorelbine and cisplatin
  • gemcitabine and cisplatin

The most common chemotherapy drugs used alone to treat salivary gland cancer are:

  • cisplatin
  • vinorelbine
  • paclitaxel
  • mitoxantrone
  • epirubicin
  • fluorouracil
  • docetaxel (Taxotere)

Targeted therapy

Targeted therapy may be offered for stage 4 salivary gland cancer if the cancer cells have certain genetic changes that are identified using cell and tissue studies.

Neurotrophic tyrosine receptor kinase (NTRK) therapy may be offered if the salivary gland cancer cells have a mutation in the NTRK gene. Cancer cells that have changes to this gene are called TRK-fusion positive.

Stage 4 salivary gland cancer that is TRK-fusion positive may be treated with:

  • larotrectinib (Vitrakvi)
  • entrectinib (Rozlytrek)

If you can't have or don't want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with salivary gland cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • American Cancer Society. Treatment options by stage of salivary gland cancer. 2017.
  • Deschler DG, Emerick KS, Wirth LJ, Busse PM . Management of salivary gland tumors: general principles and management. Harrison LB, Sessions RB, Kies MS (eds.). Head and Neck Cancer: A Multidisciplinary Approach. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014: 25(A): 697-724.
  • National Cancer Institute. Salivary Gland Cancer Treatment (Adult) (PDQ®) Health Professional Version. 2018.
  • Locati LD, Guzzo M, Orlandi E, Licitra L . Management of salivary gland cancer. Bernier J (ed.). Head and Neck Cancer: Multimodality Management. Springer; 2016: 36:625-640.
  • National Cancer Institute. Salivary Gland Cancer Treatment (Adult) (PDQ®) Patient Version. 2018.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers Version 2.2018. 2018.
  • Bebb DG, Banerji S, Blais N, et al. Canadian consensus for biomarker testing and treatment of TRK fusion cancer in adults. Current Oncology. 2021: 28(1):523–548. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903287/.
  • Bayer Inc. Product Monograph: Vitrakvi. https://pdf.hres.ca/dpd_pm/00060963.PDF.