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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—based on the level of risk the tumor respresents. 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 treatment19Agulnik M, McGann CF, Mittal BB, Godon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev (2008) 2:86–94.

  • 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 follows:21Seethala 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 carcinoma
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

a Intermediate 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.

b Adenoid 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

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17 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.

18 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. p. 220–1.

19 Agulnik M, McGann CF, Mittal BB, Godon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev (2008) 2:86–94.

20 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.

21 Seethala RR. An Update on Grading of Salivary Gland Carcinomas. Head Neck Pathol. 2009 March;3(1): 69–77.

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30 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.