Salivary Gland Cancer Stages

After someone is diagnosed with salivary gland cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage salivary gland cancers are stage 0 (carcinoma in situ), and then stages range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for salivary gland cancers is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The extent of the tumor (T): How large is the cancer? Has it grown into nearby structures?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?

The system described here is the most recent AJCC system, effective January 2018.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.

The staging system in the table is the pathologic stage (also called the surgical stage). It is determined by examining tissue removed during an operation. Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patient’s outlook as accurately as a pathologic stage.

Salivary gland staging can be complex, so ask your doctor to explain it to you in a way you understand. 

AJCC stage

Stage grouping

Stage description*

0

Tis

N0

M0

The cancer is confined to the cells lining the salivary duct (Tis).

It has not spread to nearby lymph nodes (N0) or distant sites (M0). This stage is also known as carcinoma in situ (Tis).

I

T1

N0

M0

The cancer is 2 cm (about ¾ inch) or smaller. It’s not growing into nearby tissues (T1).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

 

II

T2

N0

M0

The cancer is larger than 2 cm but no larger than 4 cm (about 1½ inch).

It’s not growing into nearby tissues (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

III

 

T3

N0

M0

The cancer is larger than 4 cm and/or is growing into nearby soft tissues (T3).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

OR

T0, T1, T2, T3

N1

M0

The cancer is any size and might have grown into nearby soft tissues (T0-T3) AND has spread to 1 lymph node on the same side of the head or neck as the primary tumor.

The cancer has not grown outside of the lymph node and the lymph node is no larger than 3 cm (about 1¼ inch) (N1). It has not spread to distant sites (M0).

IVA

T4a

N0 or N1

M0

The cancer is any size and is growing into nearby structures such as the jaw bone, skin, ear canal, and/or facial nerve. This is known as moderately advanced disease T4a) AND:

  • It has not spread to nearby lymph nodes (N0) OR
  • It has spread to 1 lymph node on the same side of the head or neck as the primary tumor, but has not grown outside of the lymph node and the lymph node is no larger than 3 cm (about 1¼ inch) (N1).

It has not spread to distant sites (M0).

OR

T0, T1, T2, T3 or T4a

N2

M0

The cancer is any size and might have grown into nearby soft tissues or structures such as the jaw bone, skin, ear canal, and/or facial nerve (T0-T4a) AND any of the following:

  • It has spread to 1 lymph node on the same side as the primary tumor but has not grown outside of the lymph node and the lymph node is larger than 3 cm but not larger than 6 cm (about 2½ inches) (N2a) OR
  • It has spread to more than 1 lymph node on the same side as the primary tumor, but it has not grown outside of any of the lymph nodes and none of the lymph nodes are larger than 6 cm (N2b) OR
  • It has spread to 1 or more lymph nodes, but has not grown outside any of the lymph nodes and none are larger than 6 cm, either on the opposite side of the primary tumor or on both sides of the neck (N2c).

It has not spread to distant organs (M0).

 

IVB

Any T

N3

M0

The cancer is any size and might have grown into nearby soft tissues or structures (Any T) AND any of the following:

  • it has spread to a lymph node that is larger than 6 cm but has not grown outside of the lymph node (N3a) OR
  • it has spread to a lymph node that is larger than 3 cm and has clearly grown outside the lymph node (N3b) OR
  • it has spread to more than one lymph node on the same side, the opposite side or both sides of the primary cancer with growth outside of the lymph node(s) (N3b) OR
  • it has spread to a lymph node on the opposite side of the primary cancer that is 3 cm or smaller and has grown outside of the lymph node (N3b). 

It has not spread to distant organs (M0).

OR

T4b

Any N

M0

The cancer is any size and is growing into nearby structures such as the base of the skull or other bones nearby, or it surrounds the carotid artery. This is known as very advanced disease (T4b).

It might or might not have spread to nearby lymph nodes (Any N). It has not spread to distant organs (M0).

IVC

Any T

Any N

M1

The cancer is any size and may have grown into nearby soft tissues or structures (Any T) AND it might or might not have spread to nearby lymph nodes (Any N).

It has spread to distant sites such as the lungs (M1).

 

 

* The following additional categories are not listed on the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • T0: No evidence of a primary tumor. The N categories are described in the table above, except for:
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Joint Committee on Cancer. Major Salivary Glands. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:95.

Last Medical Review: December 21, 2017 Last Revised: December 21, 2017

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