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Oral Salivary Gland Cancer

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of oral cancer. In general, doctors know there are several characteristics of the tumor that can tell you something about your chances of being cured. The following aspects of the cancer may affect your prognosis.

Stage This is the most important factor that affects your chances of being cured.
Site Major salivary gland cancers have a better prognosis than minor salivary gland cancers, though this may be because minor salivary gland cancers are at a greater stage when they are discovered and because it can be harder to completely remove them.
Type and Grade How aggressive a tumor is, is actually based on the type and grade of tumor (as in the chart about low-risk and high-risk types of tumors above).
Spread to Lymph Nodes This goes along with stage, but even without other factors, if there is spread to lymph nodes in the neck, there is a lower chance of cure.22Terhaard 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.
The Tumor Margins The ability to completely remove the tumor is most often the single most important factor that will indicate whether you will be cured.
Spread into Local Structures Spread into large nerves, skin and bone has been shown to indicate a worse prognosis.23Spiro, et al. Stage means more than grade in adenoid cystic carcinoma. The American Journal of Surgery. 1992;164(6):623-628.

It is very difficult to discuss prognosis without understanding all the details of your cancer, and this is a conversation you’re better off having in person with your doctor. To give you a percentage chance of cure is really difficult because cancer research looks at all sorts of different types of cancers and may include patients from long ago. In general, for patients with cancer of the oral cavity, studies have shown the following9, 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.:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at Ten Years
Minor Salivary Gland Cancers (1966-1991) Adenoid Cystic Carcinoma (1966-1991)
Stage I 83% 75%
Stage II 53% 43%
Stage III 35% 15%
Stage IV 24% 15%

Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.

Just to be complete, a few other major studies have looked at survival as well, and they found the following results:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at 10 Years
(minor salivary
gland cancer)16WHO histological classification of tumors of the salivary glands. World Health Organization. 2005.
Estimated Disease-Specific Survival at 10 Years (adenoid
cystic carcinoma)17Seethala RR. An update on grading of salivary gland carcinomas. Head Neck Pathol. 2009 March;3(1):69-77.
Salivary Gland
Cancer (all sites)*
Minor Salivary Gland Cancers Adenoid Cystic
Carcinoma
1966-1991 1966-1991
Stage I 77% 83% 75%
Stage II 58% 53% 43%
Stage III 51% 35% 15%
Stage IV 30% 24% 15%

*This Dutch study analyzed over 550 patients with salivary gland cancers of all sites including parotid gland (332 patients), submaxillary gland (76 patients), oral cavity minor salivary glands (129 patients) and laryngopharyngeal minor salivary glands (28 patients).

Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage

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.