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Blog, Head and Neck Cancer

Staging and Treatment of Salivary Glands Tumor


Staging systems are used to describe the severity of cancer based on the size, extent of invasion, and spread to different body parts. It helps to determine treatment strategy and disease prognosis. TNM is the most commonly used system for staging salivary glands cancers. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 1, 2, 3, 4a, and 4b), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these factors. Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of salivary glands cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Stage TNM Score Stage Description

 

Preferred Treatment
I T1 N0 M0 The primary tumor is </=2 cm in size without invasion into any nearby tissue. No spread to nearby lymph nodes or distant body parts. For most Stage I to II cancers, surgery is considered as the preferred treatment. Surgical resection of the involved site is generally employed along with lymph node dissection as the primary treatment. Radiation therapy with or without chemotherapy may be employed after the primary treatment to kill any remaining cancer cells or in the case of high-grade cancers.
II T2 N0 M0 The primary tumor is >2 cm but </=4 cm in size without invasion into any nearby tissue. No spread to nearby lymph nodes or distant body parts.
III T3 N0 M0

 

The primary tumor is >4 cm in size and/or has invaded a nearby tissue. No spread to nearby lymph nodes or distant body parts. For most Stage III cancers, surgery is considered as the preferred treatment. Surgical resection of the primary tumor among with affected nearby tissue is generally employed along with lymph node dissection as the primary treatment. Radiation therapy with or without chemotherapy may be employed after the primary treatment to kill any remaining cancer cells or in the case of high-grade cancers.
T0-3 N1 M0 The primary tumor of any size that might have invaded a nearby tissue. The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. No spread to distant body parts.
IVA T0-3 N2 M0 The primary tumor of any size that might have invaded a nearby tissue. The disease has spread to a single ipsilateral lymph node measuring either </=3 cm with extranodal involvement or >3 cm but <6 cm without extranodal involvement; or to multiple ipsilateral or bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. No spread to distant body parts. For Stage IV cancers, when physician think that cancer can be removed completely, surgery is usually employed as first-line treatment. This is usually followed by radiotherapy with or without chemotherapy (or targeted therapy) to kill any remaining cancer cells or in the case of high-grade cancers.

When cancer cannot be removed completely or surgery is not preferred by the patient, radiation therapy combined with chemotherapy can be employed as first-line treatment. Surgery may be employed if the tumor shrinks sufficiently that it can be removed with minor surgery. Radiation therapy may be employed as palliative treatment.

T4a N0-2 M0 The primary tumor has invaded any of the adjacent structure, such as facial skin, mandible, ear canal, and/or

facial nerve. The disease might have spread to single, multiple, or bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. No spread to distant body parts.

IVB Any T N3 M0 The primary tumor of any size that might have invaded the adjacent structures. The disease has spread to lymph nodes measuring >6 cm or significant extranodal involvement. No spread to distant body parts.
T4b Any N M0 The primary tumor has invaded a vital structure, such as the skull base, pterygoid plates, and/or surrounds the carotid artery. The disease might or might not have spread to lymph nodes. No spread to distant body parts.
IVC Any T Any N M1 The primary tumor of any size that might have invaded the adjacent structures. The disease might or might not have spread to lymph nodes. The disease has spread to a distant body part, such as the lungs.

 

Palliative Treatment: It helps in improving the overall quality of life by providing relief from the symptoms and by reducing the suffering caused by HNC and its treatment. It is generally given as supportive care for advanced staged HNCs, along with other treatments. It may include but not limited to: using drugs or other interventions to reduce pain, bleeding, and other symptoms; surgical interventions like gastrostomy or tracheostomy to support nutrition or respiration; support and counselling for speech, swallowing, and oral hygiene-related problems; and radiation therapy to palliate pain, bleeding, obstructive problems, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes, patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of Staging and Treatment of Salivary Glands Tumor:

  • Prolongation of life.
  • Reduction of symptoms.
  • Improvement of overall quality of life.

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