Major Salivary Glands Cancer Staging
Updated: Jan 15, 2020
Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS
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 |