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