Salivary Gland Cancer: Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until the doctor performs a biopsy. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for salivary gland cancer:

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: Indicates the primary tumor cannot be evaluated.

T0: No evidence of a tumor is found.

T1: Describes a small, noninvasive (has not spread) tumor that is 2 centimeters (cm) at its greatest dimension.

T2: Describes a larger, noninvasive tumor between 2 cm to 4 cm.

T3: Describes a tumor that is larger than 4 cm, but not larger than 6 cm, that has spread beyond the salivary glands but does not affect the seventh nerve, the facial nerve that controls expression, such as smiles or frowns.

T4a: The tumor invades the skin, jawbone, ear canal, and/or facial nerve.

T4b: The tumor invades the skull base and/or the nearby bones and/or encases the arteries.

Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. There are many nodes located in the head and neck area, and careful evaluation of lymph nodes is an important part of staging cancer of the major salivary glands.

NX: Indicates the regional lymph nodes cannot be evaluated.

N0: There is no evidence of cancer in the regional nodes.

N1: Indicates that cancer has spread to a single node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller.

N2: Describes any of these conditions:

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm, but not larger than 6 cm.

N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.

N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in lymph nodes is larger than 6 cm.

Distant metastasis. The "M" in the TNM system describes cancer that has spread to other parts of the body.

MX: Indicates distant metastasis cannot be evaluated.

M0: Indicates the cancer has not spread to other parts of the body.

M1: Describes cancer that has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I: Describes noninvasive tumors (T1, T2), with no spread to lymph nodes (N0) and no distant metastasis (M0).

Salivary Gland Cancer Stage I

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Stage II: Describes an invasive tumor (T3), with no spread to lymph nodes (N0) or distant metastasis (M0).

Salivary Gland Cancer Stage II

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Stage III: Describes smaller tumors (T1, T2) that have spread to regional lymph nodes (N1), but have no sign of metastasis (M0).

Salivary Gland Cancer Stage III

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Stage IVA: Describes any invasive tumor (T4a), with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1), but no metastasis (M0). It is also used for a T3 tumor with one-sided nodal involvement (N1), but no metastasis (M0), or any tumor (any T) with extensive nodal involvement (N2).

Salivary Gland Cancer Stage IVA

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Stage IVB: Describes any cancer (any T), with more extensive spread to lymph nodes (N2, N3), but no metastasis (M0).

Salivary Gland Cancer Stage IVB

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Stage IVC: Describes any cancer with distant metastasis (any T, any N, and M1).

Salivary Gland Cancer Stage IVC

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Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Grades and Subtypes

In addition to the stage of the cancer, doctors will classify the subtype of salivary gland tumor using a histologic evaluation. By looking at how tumor cells look under a microscope, doctors can also assign a grade to the cancer. To do this, the doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

There are many subtypes of salivary gland cancer, and your doctor can provide more information regarding your specific diagnosis:

Benign tumor subtypes

Pleomorphic adenoma (benign mixed tumor)

Papillary cystadenoma-lymphomatosum (Warthin’s tumor)

Oncocytoma

Monomorphic adenoma (including basal cell adenoma, glycogen-rich adenoma, and clear cell adenoma, among others)

Sebaceous adenoma

Sebaceous lymphadenoma

Papillary ductal adenoma

Benign lymphoepithelial lesion

Cancerous tumor subtypes

Carcinoma ex-pleomorphic adenoma

Mucoepidermoid carcinoma (including high grade, intermediate grade, and low grade)

Hybrid basal cell carcinoma-adenoid cystic carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma

Adenocarcinoma

Polymorphous low-grade adenocarcinoma

Oncocytic carcinoma (malignant oncocytoma)

Clear cell carcinoma

Epithelial-myoepithelial carcinoma of intercalated ducts

Squamous cell carcinoma

Undifferentiated carcinoma

Metastatic carcinoma

Source: Tumors of the Head and Neck, Clinical and Pathological Considerations 2nd Edition, John G. Batsakis, MD, Copyright 1979, published by The Williams & Wilkins Company.

Information about the cancer’s stage and grade will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.