Stages of Salivary Gland Cancer

After salivary gland cancer has been diagnosed, tests are done to find out if cancer cells have spread within the salivary gland or to other parts of the body.

The process used to find out if cancer has spread within the salivary glands or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if salivary gland cancer spreads to the lung, the cancer cells in the lung are actually salivary gland cancer cells. The disease is metastatic salivary gland cancer, not lung cancer.

The following stages are used for salivary gland cancers that affect the parotid, submandibular, and sublingual glands:

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the salivary ducts or the small sacs that make up the salivary gland. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. The tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II

In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III

In stage III, one of the following is true:

• The tumor is larger than 4 centimeters, and/or cancer has spread to soft tissue around the salivary gland; or
• The tumor is any size, and cancer may have spread to soft tissue around the salivary gland. Cancer has spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller, and cancer has not grown outside the lymph node.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

• Stage IVA:
  • Cancer has spread to the skin, jawbone, ear canal, and/or facial nerve. Cancer may have spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller, and cancer has not grown outside the lymph node; or
  • The tumor is any size, and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
    • to one lymph node on the same side of the head or neck as the tumor or on the side opposite the primary tumor; the lymph node is 3 centimeters or smaller, and cancer has grown outside the lymph node; or
    • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters but not larger than 6 centimeters, and cancer has not grown outside the lymph node; or
    • to more than one lymph node on the same side of the head or neck as the tumor; the lymph nodes are 6 centimeters or smaller, and cancer has not grown outside the lymph nodes; or
    • to lymph nodes on both sides of the head or neck or on the side opposite the primary tumor; the lymph nodes are 6 centimeters or smaller, and cancer has not grown outside the lymph nodes.
• Stage IVB:
  • The tumor is any size, and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
    • to one lymph node larger than 6 centimeters, and cancer has not grown outside the lymph node; or
    • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters, and cancer has grown outside the lymph node; or
    • to more than one lymph node on the same side of the head or neck as the tumor, on the side opposite the primary tumor, or on both sides of the head or neck; cancer has grown outside any of the lymph nodes; or
    • to one lymph node of any size on the side of the head or neck opposite the primary tumor; cancer has grown outside the lymph node;

      or

  • Cancer has spread to the bottom of the skull and/or surrounds the carotid artery. Cancer may have spread to one or more lymph nodes of any size on either or both sides of the head or neck and may have grown outside the lymph nodes.
• Stage IVC:
  • Cancer has spread to other parts of the body, such as the lungs.

Minor salivary glands are staged differently from the parotid, submandibular, and sublingual glands.

Minor salivary gland (small salivary glands lining parts of the mouth, nose, and larynx) cancers are staged according to where they were first formed, such as the oral cavity or sinuses.

Salivary gland cancer can recur (come back) after it has been treated.

The cancer may come back in the salivary glands or in other parts of the body.