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Oral Salivary Gland Cancer

Determining the Grade of the Tumor

In addition to the tumor type, your doctor should also let you know what grade the tumor is—low-grade, intermediate-grade or high-grade. The grade of the tumor is based on a number of factors the pathologist will identify.

The histological grade is particularly important for your doctor to know in the following types of tumors because it can actually influence prognosis and treatment22Terhaard CHJ, et al. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head & Neck. 2004;26(8):681-693.:

  • Mucoepidermoid Carcinoma
  • Adenocarcinoma NOS
  • Adenoid Cystic Carcinoma
  • Squamous Cell Carcinoma

In other types of salivary gland cancers, the grade of the cancer is not always necessary because certain types are intrinsically high-grade (high-risk) or intrinsically low-grade (low risk) based on the type alone. However, sometimes a typically low-grade tumor can have a high-grade variant, and a typically high-grade tumor can have a low-grade variant. If this is the case, the pathologist should indicate this on the report. A general guide to what grade your cancer might be is as follows17Seethala RR. An update on grading of salivary gland carcinomas. Head Neck Pathol. 2009 March;3(1):69-77.:

Intrinsically Low-Grade Intrinsically High-Grade
Low-grade mucoepidermoid carcinomaa
Acinic cell carcinoma
Epithelial-myoepithelial carcinoma
Polymorphous low-grade adenocarcinoma
Clear cell carcinoma
Basal cell adenocarcinoma
Low-grade salivary duct carcinoma (low-grade cribriform cystadenocarcinoma)
Myoepithelial carcinoma
Oncocytic carcinoma
Carcinoma ex pleomorphic adenoma (intracapsular/minimally invasive or with low-grade histology)
Sialoblastoma
High-grade mucoepidermoid carcinoma
Sebaceous carcinoma and lymphadenocarcinoma
Adenoid cystic carcinomab
Mucinous adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
Large cell carcinoma
Lymphoepithelial carcinoma
Metastasizing pleomorphic adenoma
Carcinoma ex pleomorphic adenoma (widely invasive or high-grade histology)
Carcinosarcoma
Adenocarcinoma and cystadenocarcinoma, NOS, high-grade
Ductal Carcinoma

aIntermediate-grade variants of these tumors are controversial in the assignment of risk. For mucoepidermoid carcinoma, this may depend on the grading scheme used. For adenocarcinoma NOS, there is little data, but what is present suggests that intermediate-grade should be placed in the high-risk group.

bAdenoid cystic carcinomas are all considered high-risk in terms of local recurrence, but only solid adenoid cystic carcinoma (i.e., high pattern grade) is considered high-risk for nodal metastasis.

References

1 Kakarala K, Bhattacharyya N. Survival in oral cavity minor salivary gland carcinoma. Otolaryngol Head Neck Surg. 2010 Jul;143(1):122-6.

2 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.

3 Petersen PE, Oral cancer prevention and control – The approach of the World Health Organization. Oral Oncol. 2008.

4 Johansen C, Boice Jr JD, McLaughlin JK, Olsen JH. Cellular telephones and cancer—a nationwide cohort study in Denmark. Journal of the National Cancer Institute. 2001;93:203-7.

5 Auvinen A, Hietanen M, Luukkonen R, Koskela RS. Brain tumors and salivary gland cancers among cellular telephone users. Epidemiology. 2002;13:356.

6 Atula T, Grenman R, Klemi P, et al. Human papillomavirus, Epstein-Barr virus, human herpes virus 8 and human cytomegalovirus involvement in salivary gland tumours. Oral Oncol. 1998;34:391-395.

7 Sun EC, Curtis R, Melbye M, et al. Salivary gland cancer in the United States. Cancer Epidemiol Biomarkers.1999;Prev 8:1095-1100.

8 Horn-Ross PL, Ljung BM, Morrow M. Environmental factors and the risk of salivary gland cancer. Epidemiology. 1997:414-9.

9 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

10 Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol. 1993;11:1751-6.

11 Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010 Mar 10;28(8):1395-400.

12 Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998;124:455-9.

13 Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, Gray HW, McCurrach GM, Bessent RG, MacLeod TIF, Robertson AG. 2001. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer. 91:2077-2083.

14 Agulnik M, McGann CF, Mittal BB, Gordon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev. 2008;2:86-94.

15 Eveson JW, Auclair PL, Gnepp DR, et al. Tumors of the salivary glands: introduction. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics. Head and neck tumours. Lyon: IARCPress; 2005:220-1.

16 WHO histological classification of tumors of the salivary glands. World Health Organization. 2005.

17 Seethala RR. An update on grading of salivary gland carcinomas. Head Neck Pathol. 2009 March;3(1):69-77.

18 Douglas JG, Koh WJ, Austin-Seymour M, Laramore GE: Treatment of salivary gland neoplasms with fast neutron radiotherapy. Arch Otolaryngol Head Neck Surg.2003;129:944-948.

19 Rentschler R, Burgess MA, Byers R. Chemotherapy of malignant major salivary gland neoplasms. A 256–94.de in oralinked above experience. Cancer. 2006;40:619-24.

20 Suen JY, Johns ME. Chemotherapy for salivary gland cancer. The Laryngoscope. 2009;92:235-9.

21 Kakarala K, Bhattacharyya N. Survival in oral cavity minor salivary gland carcinoma. Otolaryngol Head Neck Surg. 2010 Jul;143(1):122-6.

22 Terhaard CHJ, et al. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head & Neck. 2004;26(8):681-693.

23 Spiro, et al. Stage means more than grade in adenoid cystic carcinoma. The American Journal of Surgery. 1992;164(6):623-628.