Salivary gland tumor staging: Difference between revisions
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==Overview== | ==Overview== | ||
According to the [[TNM]] | 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]]. | ||
==Staging== | ==Staging== | ||
The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define salivary gland cancer. | 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.<ref name="NIH"> 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</ref> | 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.<ref name="NIH"> 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</ref> | ||
===Primary tumor (T)=== | ===Primary tumor (T)=== | ||
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===Tumor grades of salivary gland cancer=== | ===Tumor grades of salivary gland cancer=== | ||
Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.<ref name="CCS"> Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015</ref> | Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the biopsy sample is examined under a microscope. A grade is given based on how the cancer [[cells]] look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.<ref name="CCS"> Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015</ref> | ||
The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth. | The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth. | ||
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Grading for salivary gland cancers is used mainly for mucoepidermoid carcinomas, adenocarcinomas, adenocarcinoma NOS, squamous cell carcinomas and adenoid cystic carcinomas. Other salivary gland cancers can also be graded in the same way. | Grading for salivary gland cancers is used mainly for [[mucoepidermoid]] carcinomas, [[adenocarcinomas]], adenocarcinoma NOS, [[squamous cell carcinomas]] and [[adenoid]] [[cystic]] carcinomas. Other salivary gland cancers can also be graded in the same way. | ||
Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis (future outcome). However, the grade is not the only factor used to predict the future outcome. It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate- or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III. | Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis (future outcome). However, the grade is not the only factor used to predict the future outcome. It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate- or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III. | ||
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[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Rare cancers]] |
Revision as of 15:33, 13 November 2015
Salivary gland tumor Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Salivary gland tumor staging On the Web |
American Roentgen Ray Society Images of Salivary gland tumor staging |
Risk calculators and risk factors for Salivary gland tumor staging |
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.
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)
Stage | Tumor location |
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Primary tumor cannot be assessed |
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No evidence of a primary tumor |
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Tumor ≤2 cm in greatest dimension without extraparenchymal extension |
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Tumor >2 cm but ≤4 cm in greatest dimension without extraparenchymal extension b |
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Tumor >4 cm and/or tumor having extraparenchymal extension b |
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b 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 |
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Regional lymph nodes cannot be assessed |
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No regional lymph node metastasis |
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Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension |
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Distant Metastasis (M)
N classification | Nodal Mass |
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No distant metastasis |
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Distant metastasis |
Anatomic Stage/Prognostic Groups
Stage | T | N | M |
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Tumor grades of salivary gland cancer
Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.[2]
The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth.
Grade | Description |
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low | Well differentiated – slow growing, less likely to spread |
Intermediate | Moderately well-differentiated |
High |
poorly differentiated – tend to grow quickly, more likely to spread |
Grading for salivary gland cancers is used mainly for mucoepidermoid carcinomas, adenocarcinomas, adenocarcinoma NOS, squamous cell carcinomas and adenoid cystic carcinomas. Other salivary gland cancers can also be graded in the same way. Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis (future outcome). However, the grade is not the only factor used to predict the future outcome. It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate- or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III.
Low grade | Low, intermediate or high grade | High grade |
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Acinic cell carcinoma | Adenocarcinoma not otherwise specified (NOS) | Adenoid cystic carcinoma* |
Basal cell adenocarcinoma | Mucoepidermoid carcinoma | Anaplastic small cell carcinoma |
Clear cell carcinoma | Squamous cell carcinoma | Carcinosarcoma |
Cystadenocarcinoma | Small and large cell undifferentiated carcinoma | |
Epithelia-myoepithelial carcinoma | Salivary duct carcinoma | |
Mucinous adenocarcinoma | Carcinoma ex pleomorphic adenoma | |
Polymorphous low-grade adenocarcinoma (PLGA) |
- *Some adenoid cystic carcinomas can also be intermediate grade.
References
- ↑ 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
- ↑ Grades of salivary gland cancer. Canadian cancer society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/grading/?region=sk Accessed on November 8, 2015