TNM Classification for Cancer of Major Salivary Glands (Parotid, Submandibular, and Sublingual)

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications for cancer of the major salivary glands (parotid, submandibular, and sublingual) are provided below, along with anatomic staging.^{[1, 2]}

Table 1. TNM classification (Open Table in a new window)

Primary tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
T1	Tumor ≤2 cm in greatest dimension without extraparenchymal extension*
T2	Tumor >2 cm but not more than 4 cm in greatest dimension without extraparenchymal extension*
T3	Tumor >4 cm and/or tumor having extraparenchymal extension*
T4	Moderately advanced or very advanced disease
T4a	Moderately advanced disease Tumor invades the 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)
	Clinical N (cN)
NX	Regional nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-)
N2	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) with clinically overt ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in any node(s) with clinically overt ENE (+)
	Pathological N (pN)
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 and no extranodal extension (ENE [-])
N2	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)
Distant metastasis (M)
cM0	No distant metastasis
cM1	Distant metastasis
pM1	Distant metastasis, microscopically confirmed

Table 2. Prognostic stage groups (Open Table in a new window)

Stage	T	N	M
0	Tis	N0	M0
I	T1	N0	M0
II	T2	N0	M0
III	T3	N0	M0
III	T0–T3	N1	M0
IVA	T4a	N0–N1	M0
IVA	T0–T4a	N2	M0
IVB	T Any	N3	M0
IVB	T4b	N Any	M0
IVC	T Any	N Any	M1

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Table 1. TNM classification

Primary tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
T1	Tumor ≤2 cm in greatest dimension without extraparenchymal extension*
T2	Tumor >2 cm but not more than 4 cm in greatest dimension without extraparenchymal extension*
T3	Tumor >4 cm and/or tumor having extraparenchymal extension*
T4	Moderately advanced or very advanced disease
T4a	Moderately advanced disease Tumor invades the 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)
	Clinical N (cN)
NX	Regional nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-)
N2	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) with clinically overt ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in any node(s) with clinically overt ENE (+)
	Pathological N (pN)
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 and no extranodal extension (ENE [-])
N2	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)
Distant metastasis (M)
cM0	No distant metastasis
cM1	Distant metastasis
pM1	Distant metastasis, microscopically confirmed