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Salivary Gland Cancer Treatment (PDQ®)

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Stage Information for Salivary Gland Cancer

Definitions of TNM

In general, tumors of the major salivary glands are staged according to size, extraparenchymal extension, lymph node involvement (in parotid tumors, whether or not the facial nerve is involved), and presence of metastases.[1-4] Tumors arising in the minor salivary glands are staged according to the anatomic site of origin (e.g., oral cavity and sinuses).

Clinical stage, particularly tumor size, may be the critical factor to determine the outcome of salivary gland cancer and may be more important than histologic grade.[5,6] Diagnostic imaging studies may be used in staging. With excellent spatial resolution and superior soft tissue contrast, magnetic resonance imaging (MRI) offers advantages over computed tomographic scanning in the detection and localization of head and neck tumors. Overall, MRI is the preferred modality for evaluation of suspected neoplasms of the salivary glands.[7]

Definitions of TNM

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define salivary gland cancer.[5]

Table 1. Primary Tumor (T)a
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
T1Tumor ≤2 cm in greatest dimension without extraparenchymal extension.b
T2Tumor >2 cm but ≤4 cm in greatest dimension without extraparenchymal extension.b
T3Tumor >4 cm and/or tumor having extraparenchymal extension.b
T4aModerately advanced disease.
Tumor invades skin, mandible, ear canal, and/or facial nerve.
T4bVery advanced disease.
Tumor invades skull base and/or pterygoid plates and/or encases carotid artery.

aReprinted with permission from AJCC: Major salivary glands (parotid, submandibular, and sublingual) . In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 79-86.
bExtraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues. Microscopic evidence alone does not constitute extraparenchymal extension for classification purposes.

Table 2. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Major salivary glands (parotid, submandibular, and sublingual) . In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 79-86.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension.
N2Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
Metastases in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension.
Metastases in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension.
N2aMetastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
N2bMetastases in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension.
N2cMetastases in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension.
N3Metastasis in a lymph node, > 6 cm in greatest dimension.

Table 3. Distant Metastasis (M)a
aReprinted with permission from AJCC: Major salivary glands (parotid, submandibular, and sublingual) . In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 79-86.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage T N M 
aReprinted with permission from AJCC: Major salivary glands (parotid, submandibular, and sublingual) . In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 79-86.
IT1N0M0
IIT2N0M0
IIIT3N0M0
T1N1M0
T2N1M0
T3N1M0
IVAT4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
IVBT4bAny NM0
Any TN3M0
IVCAny TAny NM1

References
  1. Spiro RH, Huvos AG, Strong EW: Cancer of the parotid gland. A clinicopathologic study of 288 primary cases. Am J Surg 130 (4): 452-9, 1975.  [PUBMED Abstract]

  2. Fu KK, Leibel SA, Levine ML, et al.: Carcinoma of the major and minor salivary glands: analysis of treatment results and sites and causes of failures. Cancer 40 (6): 2882-90, 1977.  [PUBMED Abstract]

  3. Levitt SH, McHugh RB, Gómez-Marin O, et al.: Clinical staging system for cancer of the salivary gland: a retrospective study. Cancer 47 (11): 2712-24, 1981.  [PUBMED Abstract]

  4. Kuhel W, Goepfert H, Luna M, et al.: Adenoid cystic carcinoma of the palate. Arch Otolaryngol Head Neck Surg 118 (3): 243-7, 1992.  [PUBMED Abstract]

  5. Major salivary glands (parotid, submandibular, and sublingual). In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 79-82. 

  6. Spiro RH: Factors affecting survival in salivary gland cancers. In: McGurk M, Renehan AG, eds.: Controversies in the Management of Salivary Gland Disease. Oxford, UK: Oxford University Press, 2001, pp 143-50. 

  7. Shah GV: MR imaging of salivary glands. Magn Reson Imaging Clin N Am 10 (4): 631-62, 2002.  [PUBMED Abstract]