Remembering Roger Ebert — and Understanding Salivary Gland and Thyroid Cancer

What he lost, and what he kept

NPR's obituary set out the sequence. Roger Ebert was treated for salivary gland cancer, thyroid cancer, and cancer of the jawbone. "In 2006, Ebert lost his jaw and with it, his ability to talk, but he still kept up an unrelenting pace, reviewing more than 200 movies a year."

He kept writing. He spoke through a digital voice on his computer. Two days before his death he posted a note announcing what he called "a leave of presence," and wrote plainly about the return of his illness. "At this point in my life, in addition to writing about movies, I may write about what it's like to cope with health challenges and the limitations they can force upon you. It really stinks that the cancer has returned and that I have spent too many days in the hospital."

He died on April 4, 2013, at the age of 70.

Those are the reported facts, and this article adds nothing to them. What follows is what these two cancers are.

Salivary gland cancer

There are three pairs of major salivary glands. The parotid glands sit in front of each ear. The submandibular glands lie under the jaw. The sublingual glands sit under the tongue. Hundreds of minor glands line the mouth, palate, and throat.

Cancer here is rare. NCI reports 1.3 cases per 100,000 people per year in the United States, from 2018 to 2022. These cancers make up about 3 to 5 percent of head and neck cancers. Most patients are in their sixties or seventies.

Most lumps in these glands are not cancer. NCI reports that more than half of salivary gland tumors are benign, and that 70 to 80 percent arise in the parotid. The odds shift sharply by site. About 20 to 25 percent of parotid tumors are malignant. So are 35 to 40 percent of submandibular tumors, about 50 percent of palate tumors, and more than 90 percent of sublingual gland tumors.

Two names come up repeatedly. Pleomorphic adenoma is the most common benign tumor, at about half of all salivary gland tumors. Mucoepidermoid carcinoma is the most common malignant one, at roughly 35 percent of malignant salivary tumors.

The cause of most of these cancers cannot be determined. NCI notes that ionizing radiation has been implicated. It also lists work links to rubber products manufacturing, asbestos mining, plumbing, and some kinds of woodworking.

The signs that separate benign from malignant

NCI is precise here, and the distinction is worth knowing.

Most tumors of these glands, benign or malignant, present as a painless swelling. A lump alone does not tell you much.

What changes the picture is nerve involvement. NCI states that signs such as numbness or weakness typically indicate a malignancy. Facial nerve weakness alongside a parotid or submandibular tumor is an ominous sign. Persistent facial pain also points strongly to cancer, though only 10 to 15 percent of malignant parotid tumors cause pain.

Thyroid cancer

The thyroid is a butterfly-shaped gland wrapped around the upper windpipe, just below the voice box. For 2026 the American Cancer Society estimates 45,240 new thyroid cancers and 2,320 deaths in the United States; NCI's PDQ summary still quotes the 2025 estimate of 44,020 and 2,290. It affects women more often than men. It usually appears between ages 25 and 65, and its incidence has been rising.

There are four main types. Papillary and follicular are the well-differentiated forms, and NCI describes them as highly treatable and usually curable. Medullary thyroid cancer is a neuroendocrine cancer with an intermediate outlook. Anaplastic thyroid cancer is uncommon, aggressive, spreads early, and carries a poorer prognosis.

Thyroid cancer often announces itself as a lump that can be felt in the neck. Doctors call it a cold nodule, because it does not take up radioactive iodine on a scan. NCI reports that 12 to 15 percent of cold nodules turn out to be cancer. The figure is higher in people under 40, and in those whose ultrasound shows calcifications.

For well-differentiated disease, NCI states that age appears to be the single most important prognostic factor. In a retrospective study of 1,019 patients, 20-year survival was 98 percent for those classified as low risk and 50 percent for those at high risk.

When to get checked

Ask for an appointment if:

• You can feel a lump in the neck, in front of the ear, under the jaw, or under the tongue, and it has been there more than three weeks.
• A lump in any of those places is growing, however slowly.
• One side of your face has become weak, droopy, or numb.
• You have persistent pain in the face or jaw with no dental cause.
• Your voice has changed or become hoarse for more than three weeks.
• Swallowing has become difficult, or something feels caught in your throat.

Facial weakness with a lump near the ear or jaw should be seen promptly rather than watched. There is no population screening test for either of these cancers, so a noticed lump is the whole route in.

Getting to a diagnosis

For thyroid nodules, NCI lists physical examination and history, plus laryngoscopy to look at the vocal cords. It also lists blood hormone and chemistry studies, ultrasound, CT scanning, fine-needle aspiration biopsy, and surgical removal.

For salivary tumors, imaging and biopsy establish the type and grade. NCI makes one point that shapes expectations. Clinical stage, and tumor size above all, may be the crucial factor in outcome. It may matter more than the grade the pathologist assigns.

What treatment involves

For localized papillary or follicular thyroid cancer, NCI lists surgery first. That means either a total thyroidectomy or a lobectomy. Radioactive iodine, thyroid-suppression therapy, and external-beam radiation follow. When disease has spread and still absorbs iodine, radioactive iodine remains an option. When it does not, targeted therapy, surgery, radiation, and chemotherapy come into play.

For salivary gland cancer, NCI states that early-stage, low-grade tumors are usually curable by surgery alone. Larger or high-grade tumors are treated with surgery, then radiation. Radiation may improve local control and survival when clear margins cannot be achieved. Tumors that cannot be removed may respond to chemotherapy.

Outcomes also depend on which gland was involved. NCI reports the prognosis is more favorable in a major gland. The parotid is most favorable, then the submandibular gland. The sublingual and minor glands are least favorable.

What surgery in this region can cost

The facial nerve runs directly through the parotid gland. Operations here can affect facial movement, speech, chewing, and swallowing. That is why care comes from teams that include surgeons, radiation oncologists, speech-language pathologists, and dietitians. Rehabilitation is part of the plan, not an afterthought.

All the percentages above describe groups of patients studied over years. They do not forecast any individual's course, and they did not forecast his.

Sources

• https://www.cancer.gov/types/head-and-neck/hp/adult/salivary-gland-treatment-pdq
• https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq
• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://www.npr.org/sections/thetwo-way/2013/04/04/176261560/roger-ebert-legendary-film-critic-dies
• https://www.cancer.org/research/cancer-facts-statistics.html