Salivary gland tumor staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of salivary gland cancers based on the tumor size, lymph nodes involved, and metastasis.[1]

Staging

  • The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define salivary gland cancer. 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.
  • 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. 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.[1]

Primary tumor (T)

T Classification Thickness
TX
Primary tumor cannot be assessed
T0
No evidence of a primary tumor
T1
Tumor ≤2 cm in greatest dimension without extraparenchymal extension
T2
Tumor >2 cm but ≤4 cm in greatest dimension without extraparenchymal extension*
T3
Tumor >4 cm and/or tumor having extraparenchymal extension*
T4a
  • Moderately advanced disease.
  • Tumor invades skin, mandible, ear canal, and/or facial nerve
T4b
  • Very advanced disease
  • Tumor invades skull base and/or pterygoid plates and/or encases carotid artery

*Extraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues. Microscopic evidence alone does not constitute extraparenchymal extension for classification purposes.

Regional Lymph Nodes (N)

N classification Nodal Mass
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension
N2
  • Metastasis 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
N2a
  • Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension
N2b
  • Metastases in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension
N2c
  • Metastases in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension
N3
  • Metastases in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension

Distant Metastasis (M)

M Classification Definition
M0
No distant metastasis
M1
Distant metastasis

Anatomic Stage/Prognostic Groups

Stage T N M
Stage 1
  • T1
  • N0
  • M0
Stage II
  • T2
  • N0
  • M0
Stage III
  • T3
  • T1
  • T2
  • T3
  • N0
  • N1
  • N1
  • N1
  • M0
  • M0
  • M0
  • M0
Stage IVA
  • T4a
  • T4a
  • T1
  • T2
  • T3
  • T4a
  • N0
  • N1
  • N2
  • N2
  • N2
  • N2
  • M0
  • M0
  • M0
  • M0
  • M0
  • M0
Stage IVB
  • T4b
  • Any T
  • Any N
  • N3
  • M0
  • M0
Stage IVC
  • Any T
  • Any N
  • M1

References

  1. 1.0 1.1 Salivary gland cancer. National cancer institute(2015) http://www.cancer.gov/types/head-and-neck/hp/salivary-gland-treatment-pdq#section/_13 Accessed on November 8, 2015

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