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Salivary Gland Cancer

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. Will you survive? Will the cancer come 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 evidence of growth to lymph nodes in the neck, there is a lower chance of cure.
The Tumor Margins Some would argue that the ability to completely remove the tumor is 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.14Wierzbicka M, Kopeć T, Szyfter W, Kereiakes T, Bem G. The presence of facial nerve weakness on diagnosis of a parotid gland malignant process. European Archives of Oto-Rhino-Laryngology 2012:1-6.

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 salivary glands, studies of large national databases have shown the following:29Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck in Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at 10 Years
Salivary Gland Cancer Salivary Gland Cancer
Stage I 96% 92%
Stage II 77% 67%
Stage III 73% 58%
Stage IV 37% 28%

These databases have analyzed prognosis based on the grade of the cancer and have shown the following:29Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck in Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at 10 Years
Salivary Gland Cancer Salivary Gland Cancer
Grade I 70% 57%
Grade II 60% 47%
Stage III-IV 39% 29%

Finally, these studies also looked at survival based on the type of salivary gland cancer:29Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck in Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at 10 Years
Salivary Gland Cancer Salivary Gland Cancer
Squamous Cell Carcinoma 46% 37%
Adenocarcinoma 60% 49%
Adenoid Cystic Carcinoma 84% 71%
Mucoepidermoid Carcinoma, Poorly Differentiated 90% 85%
Acinic Cell Carcinoma 96% 94%
Mucoepidermoid Carcinoma (Other) 96% 94%
Carcinoma in Pleomorphic Adenoma (Malignant Mixed Tumor) 82% 71%
Mucoepidermoid Carcinoma, Well Differentiated 99% 99%

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)16Schmidt RL, Hall BJ, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle biopsy for salivary gland lesions. Am J Clin Pathol 2011;136:516-26.
Estimated Disease-Specific Survival at 10 Years (adenoid
cystic carcinoma)17Agulnik M, McGann CF, Mittal BB, Gordon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev (2008) 2:86–94.
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

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14 Wierzbicka M, Kopeć T, Szyfter W, Kereiakes T, Bem G. The presence of facial nerve weakness on diagnosis of a parotid gland malignant process. European Archives of Oto-Rhino-Laryngology 2012:1-6.

15 Schmidt RL, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol 2011;136:45-59.

16 Schmidt RL, Hall BJ, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle biopsy for salivary gland lesions. Am J Clin Pathol 2011;136:516-26.

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

29 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck in Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

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.