Major Salivary Glands Cancer Staging 

Updated: Feb 06, 2018
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS  more...
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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]

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
T0–T3 N1 M0
IVA T4a N0–N1 M0
T0–T4a N2 M0
IVB T Any N3 M0
T4b N Any M0
IVC T Any N Any M1