Making an accurate diagnosis is a key first step in developing the best treatment plan for salivary gland cancer.

As part of this process, your doctor will tell you:

• which type of salivary gland cancer you have, depending on its cell type as seen under a microscope
• whether the cancer is growing slowly (low-grade salivary gland cancer) or quickly (high-grade salivary gland cancer)

First, your care team will take a complete medical history. They will want to know about any risk factors you may have, such as prior cancer treatments or exposure to radiation in the workplace.

You will also need to have a number of diagnostic tests. These include scans as well as laboratory tests. At Memorial Sloan Kettering, sophisticated pathology and imaging tests provide your care team with a great deal of information. We use this diagnostic information to formulate a personalized treatment plan.

Throughout your care, we’ll continue to use some of these tests to track the size of your tumor and assess your response to treatment.

Salivary Gland Biopsy

During a salivary gland biopsy, your surgeon removes a small amount of abnormal tissue from the gland where cancer is suspected. The tissue sample is then sent to a pathologist who examines it under a microscope. The pathologist works with the other members of your care team to make a diagnosis.

At Memorial Sloan Kettering, we have a team of pathologists whose sole focus is diagnosing cancers of the head and neck. This specialization allows them to make the most precise diagnosis possible. A more precise diagnosis can improve the effectiveness of your treatment or spare you from treatment that won’t work against your disease.

Diagnostic Imaging for Salivary Gland Cancer

Special x-rays may be done. These include CT scans, MRIs, or Panorex. A Panorex is an x-ray that shows the full upper and lower jaw, including the jaw and sinuses. These imaging tests provide more details about the tissue. If cancer is found, the scans can show how deep the cancer is and if it has spread.

At MSK, our radiologists use the most-advanced imaging technologies to safely detect and monitor cancer. Their deep knowledge of salivary gland cancer allows them to choose the imaging approach that’s best for you and to define the precise extent of your tumor.

Genomic Testing for Advanced Salivary Gland Cancer

Genomic testing is also called tumor sequencing or molecular profiling. It involves looking at the cells obtained from a biopsy to see if there are any genetic mutations. Mutations are changes in your genes. Genomic testing can say if any mutations in your cells could be linked to the type of cancer you have.

For people with advanced disease, our experts use a testing approach called MSK-IMPACT^™. The test, developed by MSK experts, screens for mutations in more than 450 genes at once.

Based on which mutations we find, we may have a drug that has been approved for the changes in your specific tumor. Or you may be able to join a clinical trial that is testing a new drug.

Genetic information about your tumor can also help us predict the chances that your cancer will return after treatment.

Almost all of these genetic changes are found only in cancer cells, not in normal cells. That means they cannot be passed on to your children. Some of these genes are very specific to certain types of salivary gland cancer and can help your pathologist make a very precise diagnosis.

For example, changes in the MYB gene are associated with adenoid cystic carcinoma. Juxtaposition of the ETV6 and NTRK3 genes is almost always found in secretory carcinoma. These genes are currently used as targets for therapy at MSK.

Hormone Receptor Status

Tumor markers are substances that are produced in excess by cancer or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. A pathologist can measure for tumor markers using a sample of tumor tissue or bodily fluid, such as blood or urine.

Our researchers are currently looking for salivary gland tumor markers that can help guide treatment decisions. For people whose tumors test positive for androgen receptors, for example, our doctors are studying the use of drug therapy that can slow or stop the growth of salivary gland tumors by blocking the production of testosterone. (Cancer cells that are androgen receptor-positive may need testosterone to grow.)