Lump that does not go away
A lump in front of the ear, at the angle of the jaw, or under the chin that lasts for weeks. A benign tumor also produces the same lump, so an examination is required.
Benign tumors of the parotid gland
CONDITION / JAWS, MOUTH AND NECK
Malignant tumors of the salivary glands.
Salivary gland cancer is a malignant tumor of the parotid, submandibular, sublingual or small salivary glands in the mouth. It is manifested by a lump that does not go away, sometimes by facial weakness or pain. They are treated mainly with surgery, if necessary with radiation therapy.
CONCEPTUAL VISUALIZATION- What it is
- Malignant tumor of one of the salivary glands - large ones near the ear and under the jaw or small ones in the mouth.
- How common
- In an international study of 5,739 salivary gland tumors, 35% were malignant.
- Alarming signs
- Lump that does not go away, gradual weakness of the face, pain, enlarged nodes on the neck.
- Who treats it
- A surgeon together with an oncologist and a radiotherapist; restoration of tissues and facial expressions — a plastic surgeon.
01 / WHAT IS ITWhat is
What is
salivary gland cancer.
Salivary glands produce saliva. There are three pairs of large ones: parotid lie in front of the ear, submandibular - under the lower jaw, sublingual - under the tongue. Hundreds of small salivary glands are scattered throughout the oral mucosa, particularly on the palate.
Tumors in these glands are mostly benign. In an international study of 5,739 tumors, 65% were benign, 35% were malignant. Benign ones most often grew in the parotid gland (70%), and malignant ones - in the small glands of the mouth (47%).
The share of malignant depends on the gland. In a study of 7,190 tumors, 22.26% of parotid gland tumors, 35.76% of submandibular tumors, 61.89% of small glands, and 92.97% of sublingual tumors were malignant.
There are many types of malignant salivary gland tumors. The most common are mucoepidermoid carcinoma (26% malignant in an international study) and adenocystic carcinoma (17%). Depending on the type, degree of malignancy and spread, what the operation will be and whether radiation is needed.
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSHow
How
malignant tumor presents.
Salivary gland cancer can look like an ordinary lump. In a study of 229 patients, 45.4% had clinical signs of malignancy, so the tumor cannot be recognized without an examination.
Facial weakness
The corner of the mouth goes down, the eye closes worse, and it grows gradually. In a study of 221 patients with progressive facial weakness due to a tumor, almost all tumors outside the temporal bone, in the area of the parotid gland, were malignant (99%).
Paralysis of the facial nervepain
Pain in the area of the tumor. In a study of 154 patients with parotid gland cancer with an advanced tumor with pain, it returned more often than in patients without pain (58.5% vs. 33.3%).
A lump in the mouth
Seals on the palate, cheek or under the tongue - this is how tumors of the small and sublingual glands are manifested.
Tumors of the oral cavityKnots on the neck
Enlarged lymph nodes on the same side of the neck - the tumor may have spread.
Metastases in the lymph nodes of the neck03 / REASONSIt depends on what
It depends on what
forecast
The course of the disease and the choice of treatment are affected by several things - they are found out during the examination and after the operation.
What a gland
Small and sublingual gland tumors are more often malignant than parotid tumors. Submaxillary - in the middle.
Tumors of the submandibular glandDegree of malignancy
It primarily depends on whether there are hidden metastases in the lymph nodes of the neck, and therefore whether to remove the nodes.
Facial nerve
In a study of 129 patients with parotid gland cancer, the tumor returned in 64% of those who had both facial weakness and nerve involvement, and in 16% who did not.
Stage and borders
In a study of 229 patients, survival was influenced by tumor size and spread, nodal involvement, stage, whether the incision margins were clean or not, and previous exposure to chemicals or radiation.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A lump in the salivary gland itself does not need an emergency, but do not postpone the examination. Separate signs are a reason to call 103.
103 immediately if:
- the face was suddenly crooked - the corner of the mouth or eye dropped;
- a person cannot raise both hands and hold them;
- suddenly it became difficult to speak - speech is unclear or confused;
- it is very difficult to breathe - a person gasps for air, suffocates or cannot utter words;
- lips or skin suddenly turned pale, blue or gray;
- the neck or face quickly swells and it becomes difficult to breathe;
- after the operation, the bleeding from the wound does not stop, even though the wound is tightly pressed.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery, pain or swelling in the wound area increases. On the same day: the wound is reddened, pus is released from it or the temperature has risen - tell the surgeon; one half of the face weakens or has stopped moving - in a few days or gradually; it became very difficult to swallow. Within 2 weeks - to the dentist: a lump appeared on the lip or in the mouth, in particular on the palate. Without delay - to the oncologist: a lump on the neck does not go away for no apparent reason or a mouth ulcer persists for more than 3 weeks. In this case, the diagnosis must be confirmed or ruled out within 28 days. In the near future - to the doctor: a lump near the ear, under the jaw, or on the neck is getting bigger, hasn't gone away in a week, is firm, or doesn't move. If the swelling of the gland persists for 3 weeks, an ultrasound is required.
05 / DIAGNOSTICSHow we make the
How we make the
diagnosis
- Review
The doctor examines the breast, mouth and neck, checks facial movements and asks how long the seal has been there and whether it has changed.
- ultrasound
If the swelling of the salivary gland persists for 3 weeks, an ultrasound is performed: it confirms the tumor and distinguishes it from other causes.
- MRI
Basic examination of a salivary gland tumor, with diffusion and contrast modes.
- Fine needle puncture
Cells from the tumor are taken with a thin needle, preferably after an MRI. In a meta-analysis of 35 studies, puncture recognized a malignant tumor in 88.0% of cases, and a benign tumor was correctly distinguished in 98.5%.
- CT scan of the neck and chest
If cancer is confirmed or highly probable: to evaluate the tumor, lymph nodes, and possible metastases. PET is certainly not recommended for this.
- Research during surgery
The removed tumor is quickly examined under a microscope during surgery to confirm cancer, determine the extent of removal and whether to remove neck nodes.
06 / TREATMENTHow we treat
How we treat
salivary gland cancer.
The main treatment is surgery with clean edges of the incision. The volume depends on where the tumor is, what type it is, and how far it has spread. European ESMO–EURACAN guidelines provide separate treatment regimens for parotid, submandibular, sublingual, and small glands; the plan is drawn up by a team of various specialists.
01
Surgery
The tumor is removed so that no tumor cells remain at the edges of the cut.
- Parotid gland
- Usually, the entire gland is removed along with the lymph nodes inside it. In the case of a tumor of a low degree of malignancy, detected already after surgery, it is enough to partially remove it with a tissue reserve.
- Other glands
- The type of operation is chosen based on the location, type and spread of the tumor.
- If the edges are not clean
- If histology finds tumor cells at the edge of the incision, it is evaluated whether it is possible to operate again, and it is done if possible.
- Neck lymph nodes
- If the nodes are enlarged, they are removed on the same side. If not enlarged, too, except for tumors with a low risk of hidden metastases.
02
Facial nerve
The nerve passes through the parotid gland.
- When the nerve is removed
- If the tumor has grown into a nerve, it is removed along with it: the authors of a study of 129 patients believe that, in high-risk cases, radiation cannot replace this.
- Instant recovery
- In a review of 18 studies (312 patients), after nerve repair in the same operation, facial movements ranging from normal to moderately impaired (House-Brackmann grade I–III) were present in 44% of patients in the 10 studies where movement was assessed using this scale; the spread between studies is large. The certainty of this evidence is very low.
- Deadlines
- After a nerve graft transplant, the nerve began to work after 6–13 months, after connecting to a branch of the masticatory nerve — after 4–6 months.
03
Exposure and surveillance
- Radiation therapy
- After surgery, it is prescribed if the tumor is large, there are metastases in the nodes, the tumor has gone beyond the gland, has grown into nerves, vessels or bone, has a high degree of malignancy, or the edges of the incision are close or not clean. Appointed by oncologist-radiotherapy.
- Irradiation and nerve
- In four comparative studies, radiation after surgery did not impair the function of the regenerated nerve.
- Supervision
- At first, examinations every 3 months, then less often, after 5 years - every year. After 3 months — pictures of the head, neck and chest. If the tumor tends to return late, annual surveillance is advised up to 15 years.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Salivary gland cancer is treated together with an oncologist: the diagnosis, tumor removal and radiation are planned by the oncology team. At Dr. Valikhnovskyi's Institute of Surgery, in the "New face" direction, tissues and facial expressions are restored after tumor removal - immediately or later.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Local flaps of the face and neck — small and medium-sized defects are covered with adjacent fabrics, the closest in color and texture.
- Microsurgical flaps — large defects, in particular together with the bone, are replaced with tissues from other parts of the body, for example, an anterolateral thigh flap; in one operation with removal, if the edges of the incision are clean, otherwise - after histology.
- Stitching of the facial nerve — if the nerve is cut, it is stitched in the first days.
- Restoring a smile — cross-facial plasty of the nerve and transplantation of a slender muscle from the thigh, when the paralysis is long; static operations improve symmetry at rest.
- Lipofilling — own fat for smoothing the contour of the face after major reconstructions.
- Facial physical therapy — exercises for facial weakness after surgery on the parotid gland.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Documents onlineSend the results of MRI, puncture or histology and a photo of the face - the doctor will pre-evaluate the situation.
- ConsultationExamination of the face, facial expressions and neck movements; talk about the plan of oncologists.
- Joint planWhat is removed, whether the nerve is affected, how and when to restore it - together with the oncologist.
- ReconstructionRestoration of tissue and nerve in one operation with removal or later.
- RecoveryHealing, exercises for the face, supervision of the oncologist according to the schedule.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is every lump in the parotid gland cancer?
No. Most tumors of the parotid gland are benign: in a study of 7,190 tumors, 22.26% were malignant. But it is impossible to distinguish them without an examination, so a lump that does not go away is checked.
Is it possible to do without surgery to find out the diagnosis?
Preliminary diagnosis is given by fine-needle puncture after MRI: in a meta-analysis of 35 studies, it recognized cancer in 88.0% of cases. The final diagnosis is confirmed by histology.
Will it be necessary to remove the facial nerve?
If the tumor has grown into a nerve, it is removed along with it, and half of the face stops moving. Therefore, the nerve is restored, often in the same operation. In a review of 18 studies, 44% of patients (10 studies) had normal to mildly impaired facial movements after such restoration, but the certainty of these data is very low. The surgeon decides whether to remove the nerve.
Is radiation therapy necessary?
No. It is prescribed after surgery if there are unfavorable signs: a large tumor, metastases in nodes, close or not clean edges, a high degree of malignancy, sprouting into nerves. The oncologist makes the decision.
Does radiation interfere with nerve regeneration?
In four comparative studies, radiation after surgery did not impair the function of the regenerated nerve.
How long should be observed after treatment?
At first every 3 months, then less often, after 5 years - every year. If the tumor tends to return late, surveillance is advised for up to 15 years.
Sources
21 sources · ESMO and REFCOR guidelines, reviews, research, NHS and NICEshowCollapse
- Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-upESMO Open, 2022doi:10.1016/j.esmoop.2022.100602 ↗
- Surgery of major salivary gland cancers: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.005 ↗
- Lymph node surgery for salivary gland cancer: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.001 ↗
- Radiotherapy for salivary gland cancer: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.006 ↗
- Diagnostic imaging of salivary gland cancers: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.007 ↗
- Cytopathological analysis of salivary gland cancer: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.002 ↗
- Post-treatment monitoring of salivary gland cancer: REFCOR recommendations by the formal consensus methodEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2024doi:10.1016/j.anorl.2023.11.003 ↗
- Distribution and Frequency of Salivary Gland Tumours: An International Multicenter StudyHead and Neck Pathology, 2022doi:10.1007/s12105-022-01459-0 ↗
- Salivary gland tumours in a northern Chinese population: a 50-year retrospective study of 7190 casesInternational Journal of Oral and Maxillofacial Surgery, 2017doi:10.1016/j.ijom.2016.09.021 ↗
- Prognostic Factors in Salivary Gland Malignancies: A Multicenter Study of 229 Patients from the Polish Salivary Network DatabaseJournal of Clinical Medicine, 2025doi:10.3390/jcm14238527 ↗
- The Prognostic Significance of Facial Nerve Involvement in Carcinomas of the Parotid GlandAmerican Journal of Clinical Oncology, 2017doi:10.1097/COC.0000000000000157 ↗
- Prognostic Significance of Pain in Parotid Gland MalignancyLaryngoscope, 2021doi:10.1002/lary.29273 ↗
- Neoplastic causes of nonacute facial paralysis: A review of 221 casesEar, Nose & Throat Journal, 2016pubmed.ncbi.nlm.nih.gov/27657317 ↗
- Application of the Milan System for Reporting Salivary Gland Cytopathology: A systematic review and meta-analysisCancer Cytopathology, 2022doi:10.1002/cncy.22604 ↗
- Facial nerve reconstruction following parotidectomy for malignancy: A systematic review of microsurgical techniques and functional outcomesJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2026.07.025 ↗
- Suspected cancer: recognition and referral (NG12) — recommendations organised by site of cancerNICE, 2026nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer ↗
- Suspected cancer: recognition and referral (NG12) — terms used in this guidelineNICE, 2026nice.org.uk/guidance/ng12/chapter/Terms-used-in-this-guideline ↗
- Bell's palsyNHS, 2023nhs.uk/conditions/bells-palsy ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Swollen glandsNHS, 2023nhs.uk/symptoms/swollen-glands ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
They found a tumor
salivary gland?
Send the results of examinations and a photo of the face. The doctor will tell you how to restore tissues and facial expressions and when it is better to do it.