Mucoepidermoid carcinoma natural history: Difference between revisions

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==Overview==
==Overview==
If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel metastasis to adjacent lymph nodes. Common complications of mucoepidermoid carcinoma include facial [[deformity]], difficulty swallowing, and local lymph node metastasis. [[Prognosis]] will generally depend on the clinical stage, tumor size, and histological grade. The overall recurrence rate will depend on the stage. Low grade tumors have a 90-98% survival rate and a low rate of local [[recurrence]].
If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel metastasis to adjacent [[Lymph node|lymph nodes]]. Common complications of mucoepidermoid carcinoma include [[facial]] [[deformity]], [[dysphagia]], and local [[lymph node]] metastasis. [[Prognosis]] will generally depend on the clinical stage, [[tumor]] size, and [[histological]] grade. The overall recurrence rate will depend on the stage. Low grade [[tumors]] have a 90-98% survival rate and a low rate of local [[recurrence]].
==Natural History==
==Natural History==
*The majority of patients with mucoepidermoid carcinoma are initially [[asymptomatic]].
*The majority of patients with mucoepidermoid carcinoma are initially [[asymptomatic]].
*Symptoms usually develop in the second or fifth decade of life, and initially patients complain of swallowing problems that are increased upon chewing activity.  
*Symptoms usually develop in the second or fifth decade of life, and initially patients complain of [[swallowing]] problems that are increased upon [[Mastication|mastication.]]
*If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel [[lymph node]] [[metastasis]].
*If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel [[lymph node]] [[metastasis]].
* Mode of metastasis may be<ref name="AsuquoNwagbara2013">{{cite journal|last1=Asuquo|first1=ME|last2=Nwagbara|first2=VI|last3=Umana|first3=AN|last4=Bassey|first4=G|last5=Ugbem|first5=T|title=Giant Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report and Review of Literature|journal=Journal of Clinical & Experimental Oncology|volume=02|issue=01|year=2013|issn=23249110|doi=10.4172/2324-9110.1000103}}</ref>
* Mode of metastasis may be<ref name="AsuquoNwagbara2013">{{cite journal|last1=Asuquo|first1=ME|last2=Nwagbara|first2=VI|last3=Umana|first3=AN|last4=Bassey|first4=G|last5=Ugbem|first5=T|title=Giant Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report and Review of Literature|journal=Journal of Clinical & Experimental Oncology|volume=02|issue=01|year=2013|issn=23249110|doi=10.4172/2324-9110.1000103}}</ref>


** lymphatic (cervical lymph node)
** [[Lymphatic]] ([[cervical]] [[lymph node]])
** haematogenous
** Hematogenous
* most common site for the metastasis is  
* Most common site for the metastasis is:
**lungs,
**[[Lungs]]
** liver
** [[Liver]]
** brain,
** [[Brain]]
** skin,
** [[Skin]]
** ovary/ peritoneum
** [[Ovary]]
** [[Peritoneum]]


==Complications==
==Complications==
*Common complications of mucoepidermoid carcinoma include:<ref name="pmid8842902">{{cite journal |vauthors=Plambeck K, Friedrich RE, Schmelzle R |title=Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients |journal=J Craniomaxillofac Surg |volume=24 |issue=3 |pages=133–9 |year=1996 |pmid=8842902 |doi= |url=}}</ref>
*Common complications of mucoepidermoid carcinoma include:<ref name="pmid8842902">{{cite journal |vauthors=Plambeck K, Friedrich RE, Schmelzle R |title=Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients |journal=J Craniomaxillofac Surg |volume=24 |issue=3 |pages=133–9 |year=1996 |pmid=8842902 |doi= |url=}}</ref>
:*Facial deformity
:*[[Facial]] deformity
:*[[Facial nerve palsy]]
:*[[Otorrhea]]  
:*[[Otorrhea]]  
:*[[Lymph node metastases|Lymph node metastasis]]
:*[[Lymph node metastases|Lymph node metastasis]]
:*[[Temporomandibular joint disorder|Temporomandibular malocclusion]]
:*[[Temporomandibular joint disorder|Temporomandibular malocclusion]]


* Cosmetic concerns leading to severe emotional stress
* [[Ulceration]]
* [[Bleeding]] from the [[tumor]]
* Compression of adjacent tissues which causes:
** [[Dysphagia]]
** [[Odynophagia]]
** Recurrence of the tumor after [[surgery]]
** [[Bones]] may undergo demineralization
** [[Submandibular tumor|Submandibular tumors]] commonly spread to the [[lymphatic system]]
** Intraoral mucoepidermoid carcinoma tumors tend to metastasize to the [[submandibular glands]], [[Post-auricular cyst|post-auricular]] and [[neck]] [[Lymph node|lymph nodes]]
** [[Palate]] [[tumors]] may metastasize to the [[skull]] base and [[respiratory tract]]
* Surgical complications: 
** [[Facial nerve palsy]]
** Gustatory sweating ([[Frey's syndrome]])
** Post-surgical wound [[infection]]
** Side effects from [[chemotherapy]] and [[radiation therapy]]
==Prognosis==
==Prognosis==
* Prognosis will generally depend on the clinical [[stage]], tumor size, and histological grade.<ref name="pmid8842902">{{cite journal |vauthors=Plambeck K, Friedrich RE, Schmelzle R |title=Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients |journal=J Craniomaxillofac Surg |volume=24 |issue=3 |pages=133–9 |year=1996 |pmid=8842902 |doi= |url=}}</ref>
* Prognosis will generally depend on the clinical [[stage]], tumor size, and histological grade.<ref name="pmid8842902">{{cite journal |vauthors=Plambeck K, Friedrich RE, Schmelzle R |title=Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients |journal=J Craniomaxillofac Surg |volume=24 |issue=3 |pages=133–9 |year=1996 |pmid=8842902 |doi= |url=}}</ref>
Line 38: Line 56:
:*Stage III 57%
:*Stage III 57%
:*Stage IV 28%
:*Stage IV 28%
MEC, have a prognosis based upon the clinical stage and histological grade with a good prognosis of MEC in children as majority of them are well differentiated or grade I neoplasm. Low grade MEC has a better 5 year survival rate from 92–100% compare to high grade MEC with 0–43% survival rate [6] with an overall incidence of lymph node involvement ranges from 18–28% [9]. When distant metastases develop in patients with minor salivary gland tumours the average survival is 2.3 years and in those with tumours of the major salivary glands is 2.6 years [10].<ref name="pmid707726">{{cite journal |vauthors=Spiro RH, Huvos AG, Berk R, Strong EW |title=Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases |journal=Am. J. Surg. |volume=136 |issue=4 |pages=461–8 |date=October 1978 |pmid=707726 |doi= |url=}}</ref><ref name="pmid16857410">{{cite journal |vauthors=Rapidis AD, Givalos N, Gakiopoulou H, Stavrianos SD, Faratzis G, Lagogiannis GA, Katsilieris I, Patsouris E |title=Mucoepidermoid carcinoma of the salivary glands. Review of the literature and clinicopathological analysis of 18 patients |journal=Oral Oncol. |volume=43 |issue=2 |pages=130–6 |date=February 2007 |pmid=16857410 |doi=10.1016/j.oraloncology.2006.03.001 |url=}}</ref>
* Overall incidence of [[lymph node]] involvement ranges from 18–28%.
 
* When distant metastases develop in patients with minor salivary gland tumours the average survival is 2.3 years  
The 5-year overall disease specific survival rate of our patients was 85%. Guzzo et al.6 and Clode et al.33 reported a 5-year overall survival rate of approximately 60% while Plambeck et al.34 91.9%, regardless of tumor grade. The high 5-year survival rate observed in our patients is probably due to the aggressive surgical treatment and the application of postoperative radiotherapy in the majority of patients. The intention to cure approach in the surgical management was evidenced with the high rate of disease free margins whereas the positive margins detected in six of our patients is attributed to the anatomical location and extend of disease.<ref name="ClodeFonseca1991">{{cite journal|last1=Clode|first1=Ana Luisa|last2=Fonseca|first2=Isabel|last3=Santos|first3=J. Rosa|last4=Soares|first4=Jorge|title=Mucoepidermoid carcinoma of the salivary glands: A reappraisal of the influence of tumor differentiation on prognosis|journal=Journal of Surgical Oncology|volume=46|issue=2|year=1991|pages=100–106|issn=00224790|doi=10.1002/jso.2930460207}}</ref>
* Tumours of the major salivary glands is 2.6 years.<ref name="pmid707726">{{cite journal |vauthors=Spiro RH, Huvos AG, Berk R, Strong EW |title=Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases |journal=Am. J. Surg. |volume=136 |issue=4 |pages=461–8 |date=October 1978 |pmid=707726 |doi= |url=}}</ref><ref name="pmid16857410">{{cite journal |vauthors=Rapidis AD, Givalos N, Gakiopoulou H, Stavrianos SD, Faratzis G, Lagogiannis GA, Katsilieris I, Patsouris E |title=Mucoepidermoid carcinoma of the salivary glands. Review of the literature and clinicopathological analysis of 18 patients |journal=Oral Oncol. |volume=43 |issue=2 |pages=130–6 |date=February 2007 |pmid=16857410 |doi=10.1016/j.oraloncology.2006.03.001 |url=}}</ref><ref name="ClodeFonseca1991">{{cite journal|last1=Clode|first1=Ana Luisa|last2=Fonseca|first2=Isabel|last3=Santos|first3=J. Rosa|last4=Soares|first4=Jorge|title=Mucoepidermoid carcinoma of the salivary glands: A reappraisal of the influence of tumor differentiation on prognosis|journal=Journal of Surgical Oncology|volume=46|issue=2|year=1991|pages=100–106|issn=00224790|doi=10.1002/jso.2930460207}}</ref>
 
<ref name="SpitzBatsakis1984">{{cite journal|last1=Spitz|first1=M. R.|last2=Batsakis|first2=J. G.|title=Major Salivary Gland Carcinoma: Descriptive Epidemiology and Survival of 498 Patients|journal=Archives of Otolaryngology - Head and Neck Surgery|volume=110|issue=1|year=1984|pages=45–49|issn=0886-4470|doi=10.1001/archotol.1984.00800270049013}}</ref><ref name="RapidisGivalos2007">{{cite journal|last1=Rapidis|first1=Alexander D.|last2=Givalos|first2=Nikolaos|last3=Gakiopoulou|first3=Hariklia|last4=Stavrianos|first4=Spyros D.|last5=Faratzis|first5=Gregory|last6=Lagogiannis|first6=George A.|last7=Katsilieris|first7=Ioannis|last8=Patsouris|first8=Efstratios|title=Mucoepidermoid carcinoma of the salivary glands.|journal=Oral Oncology|volume=43|issue=2|year=2007|pages=130–136|issn=13688375|doi=10.1016/j.oraloncology.2006.03.001}}</ref>
Distant metastasis in MECs implicates an unfavorable prognosis although the biological behavior of the metastatic deposits have a slow progression.1 When distant metastases develop in patients with minor salivary gland tumors the average survival is 2.3 years and in those with tumors of the major salivary glands is 2.6 years. This difference though is not statistically significant.25 Histological grade and tumor size are also adverse factors in the development of distant metastases.7, 26 It was interesting to note that two of our patients, both having low grade tumors and distant metastases, are alive after 48 and 110 months, respectively. They were both treated for their metastases with adjuvant radiochemotherapy which seemed to have played a leading role in the stabilization of their condition. In another two of our patients with high grade tumors, who also developed distant metastases, survival was 3 and 32 months despite additional radiochemotherapy.
 
These findings probably suggest a different biologic aggressiveness of metastases originating from low or high-grade MECs, the former not necessarily implying a poorer prognosis. Although not statistically evidenced, the study of our patients showed an association between distant metastasis and preexisting local recurrence. It can be further hypothesized that, irrespective of histological grading, local recurrence is more likely to be the causative factor in the development of distant metastases rather than the primary tumor.<ref name="SpitzBatsakis1984">{{cite journal|last1=Spitz|first1=M. R.|last2=Batsakis|first2=J. G.|title=Major Salivary Gland Carcinoma: Descriptive Epidemiology and Survival of 498 Patients|journal=Archives of Otolaryngology - Head and Neck Surgery|volume=110|issue=1|year=1984|pages=45–49|issn=0886-4470|doi=10.1001/archotol.1984.00800270049013}}</ref><ref name="RapidisGivalos2007">{{cite journal|last1=Rapidis|first1=Alexander D.|last2=Givalos|first2=Nikolaos|last3=Gakiopoulou|first3=Hariklia|last4=Stavrianos|first4=Spyros D.|last5=Faratzis|first5=Gregory|last6=Lagogiannis|first6=George A.|last7=Katsilieris|first7=Ioannis|last8=Patsouris|first8=Efstratios|title=Mucoepidermoid carcinoma of the salivary glands.|journal=Oral Oncology|volume=43|issue=2|year=2007|pages=130–136|issn=13688375|doi=10.1016/j.oraloncology.2006.03.001}}</ref>


==References==
==References==

Latest revision as of 16:02, 17 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: , Badria Munir M.B.B.S.[2] , Maria Fernanda Villarreal, M.D. [3]

Overview

If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel metastasis to adjacent lymph nodes. Common complications of mucoepidermoid carcinoma include facial deformity, dysphagia, and local lymph node metastasis. Prognosis will generally depend on the clinical stage, tumor size, and histological grade. The overall recurrence rate will depend on the stage. Low grade tumors have a 90-98% survival rate and a low rate of local recurrence.

Natural History

  • The majority of patients with mucoepidermoid carcinoma are initially asymptomatic.
  • Symptoms usually develop in the second or fifth decade of life, and initially patients complain of swallowing problems that are increased upon mastication.
  • If left untreated, patients with mucoepidermoid carcinoma may progress to develop sentinel lymph node metastasis.
  • Mode of metastasis may be[1]

Complications

  • Common complications of mucoepidermoid carcinoma include:[2]

Prognosis

  • Prognosis will generally depend on the clinical stage, tumor size, and histological grade.[2]
  • The overall recurrence rate depends on the stage of the tumor.[2][3]
  • Low grade tumors have a 90-98% survival rate and a low rate of local recurrence.
  • High grade tumors have a 30-54% survival rate, and a high local recurrence rate.[3]
  • The 5-year survival rate of patients with mucoepidermoid carcinoma is:[4]
  • Stage I 75%
  • Stage II 59%
  • Stage III 57%
  • Stage IV 28%
  • Overall incidence of lymph node involvement ranges from 18–28%.
  • When distant metastases develop in patients with minor salivary gland tumours the average survival is 2.3 years
  • Tumours of the major salivary glands is 2.6 years.[5][6][7]

[8][9]

References

  1. ↑ Asuquo, ME; Nwagbara, VI; Umana, AN; Bassey, G; Ugbem, T (2013). "Giant Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report and Review of Literature". Journal of Clinical & Experimental Oncology. 02 (01). doi:10.4172/2324-9110.1000103. ISSN 2324-9110.
  2. ↑ 2.0 2.1 2.2 Plambeck K, Friedrich RE, Schmelzle R (1996). "Mucoepidermoid carcinoma of salivary gland origin: classification, clinical-pathological correlation, treatment results and long-term follow-up in 55 patients". J Craniomaxillofac Surg. 24 (3): 133–9. PMID 8842902.
  3. ↑ 3.0 3.1 Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY (1990). "Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy". Arch. Otolaryngol. Head Neck Surg. 116 (3): 290–3. PMID 2306346.
  4. ↑ Wealey, W. V., Perzin, K. H. and Smith, L. (1970), Mucoepidermoid carcinoma of salivary gland origin. Classification, clinical-pathologic correlation, and results of treatment. Cancer, 26: 368–388. doi: 10.1002/1097-0142(197008)26:2<368::AID-CNCR2820260219>3.0.CO;2-K
  5. ↑ Spiro RH, Huvos AG, Berk R, Strong EW (October 1978). "Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases". Am. J. Surg. 136 (4): 461–8. PMID 707726.
  6. ↑ Rapidis AD, Givalos N, Gakiopoulou H, Stavrianos SD, Faratzis G, Lagogiannis GA, Katsilieris I, Patsouris E (February 2007). "Mucoepidermoid carcinoma of the salivary glands. Review of the literature and clinicopathological analysis of 18 patients". Oral Oncol. 43 (2): 130–6. doi:10.1016/j.oraloncology.2006.03.001. PMID 16857410.
  7. ↑ Clode, Ana Luisa; Fonseca, Isabel; Santos, J. Rosa; Soares, Jorge (1991). "Mucoepidermoid carcinoma of the salivary glands: A reappraisal of the influence of tumor differentiation on prognosis". Journal of Surgical Oncology. 46 (2): 100–106. doi:10.1002/jso.2930460207. ISSN 0022-4790.
  8. ↑ Spitz, M. R.; Batsakis, J. G. (1984). "Major Salivary Gland Carcinoma: Descriptive Epidemiology and Survival of 498 Patients". Archives of Otolaryngology - Head and Neck Surgery. 110 (1): 45–49. doi:10.1001/archotol.1984.00800270049013. ISSN 0886-4470.
  9. ↑ Rapidis, Alexander D.; Givalos, Nikolaos; Gakiopoulou, Hariklia; Stavrianos, Spyros D.; Faratzis, Gregory; Lagogiannis, George A.; Katsilieris, Ioannis; Patsouris, Efstratios (2007). "Mucoepidermoid carcinoma of the salivary glands". Oral Oncology. 43 (2): 130–136. doi:10.1016/j.oraloncology.2006.03.001. ISSN 1368-8375.

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