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Oral Salivary Gland Cancer

Determining the Type of Oral Salivary Gland Cancer

Only after a pathologist analyzes some cells or actual pieces of tissue from the lesion will your doctor be able to tell you if you have cancer. Your doctor and pathologist should specialize in oral cancers because some benign (non-cancerous) lesions can look like cancer on a small biopsy.

After diagnosing you with oral salivary gland cancer, your doctor will need to determine what type of cancer it is. Your doctor may be able to tell you the GRADE of the cancer (low-grade, intermediate-grade or high-grade) from your biopsy results. If there happens to be a lot of cells in the biopsy, you might even have an indication of what type of cancer it is. If your doctor is having a difficult time telling you what type of cancer it is, he or she might ask for a second opinion and send some pieces off to a specialist who deals more frequently with these types of tumors.

In any case, since the first treatment for essentially all salivary gland cancers is removal by surgery, at some point the pathologist will get a good look at the tumor under a microscope and you will hopefully know what type of salivary gland cancer you have.

Salivary gland cancer types are among the most difficult to diagnose for a number of reasons14, Agulnik M, McGann CF, Mittal BB, Gordon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev. 2008;2:86-94.15Eveson 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.:

  • These tumors are extremely rare.
  • The classification system is complex.
  • Some tumors can have features that make it difficult to differentiate benign from malignant.
  • A single tumor mass can have a whole range of characteristics and can even have two different types of tumors within it (including benign and malignant).
  • Just as there is great variation in configurations of cells within a tumor, special stains called immunostains are also quite variable within a group of similar tumors.

After a thorough analysis, a salivary gland cancer will fit into one of these tumor types as defined by the World Health Organization. The six most common ones are in bold.16WHO histological classification of tumors of the salivary glands. World Health Organization. 2005.

ALL THE DIFFERENT TYPES OF SALIVARY GLAND TUMORS

Cancerous Epithelial Tumors Cancerous Soft Tissue Tumors
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Adenocarcinoma, NOS
Carcinoma ex pleomorphic adenoma
Squamous cell carcinoma
Polymorphous low-gradeadenocarcinoma
Epithelial-myoepithelial carcinoma
Clear cell carcinoma, NOS
Basal cell adenocarcinoma
Sebaceous carcinoma
Sebaceous lymphadenocarcinoma
Cystadenocarcinoma
Low-grade cribriform
Cystadenocarcinoma
Mucinous adenocarcinoma
Oncocytic carcinoma
Salivary duct carcinoma
Myoepithelial carcinoma
Carcinosarcoma
Metastasizing pleomorphic adenoma
Small cell carcinoma
Large cell carcinoma
Lymphoepithelial carcinoma
Sialoblastoma
Haemangiopericytoma
Malignant schwannoma
Fibrosarcoma
Malignant fibrous histiocytoma
Rhabdomyosarcoma
Angiosarcoma
Synovial sarcoma
Kaposi sarcoma
Leiomyosarcoma
Liposarcoma
Alveolar soft part sarcoma
Epithelioid sarcoma
Extraosseous chondrosarcoma
Osteosarcoma
Malignant haemangioendothelioma
Blood and Lymphatic Tumors Metastatic Tumors
Hodgkin lymphoma
Diffuse large B-cell lymphoma
Extranodal marginal zone
B-cell lymphoma
A cancer that has spread to the salivary gland from another site

WHO Histological Classification of Tumors of the Salivary Glands, 2005. 16WHO histological classification of tumors of the salivary glands. World Health Organization. 2005.

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.