Home

Loading...

Table of contents

Salivary gland cancer

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of salivary gland cancer are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2023,2021,2018), the European Reference Network on Rare Adult Solid Cancers (EURACAN/ESMO 2022), the American College of Radiology (ACR 2019), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017), ...
Show more

Classification and risk stratification

Classification: as per ESMO/EURACAN 2022 guidelines, classify SGC according to the WHO Classification of Head and Neck Tumors.
A
Show 2 more
TNM classification for major salivary gland cancer
Tumor classification
Tx: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor ≤ 2 cm in greatest dimension without extraparenchymal extension (clinical or macroscopic evidence of invasion of soft tissues; microscopic evidence alone does not constitute extraparenchymal extension for classification purposes)
T2: Tumor > 2 cm but not more than ≤ 4 cm in greatest dimension without extraparenchymal extension
T3: Tumor > 4 cm and/or tumor having extraparenchymal extension
T4a: Moderately advanced disease; tumor invades skin, mandible, ear canal, and/or facial nerve
T4b: Very advanced disease; tumor invades skull base and/or pterygoid plates and/or encases carotid artery
Lymph node classification
Nx: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in a single ipsilateral lymph node, ≤ 3 cm in greatest dimension and no extranodal extension
N2: Metastasis in a single ipsilateral node > 3 cm but ≤ 6 cm in greatest dimension and no extranodal extension; or metastases in multiple ipsilateral lymph nodes ≤ 6 cm in greatest dimension and no extranodal extension; or in bilateral or contralateral lymph nodes ≤ 6 cm in greatest dimension and no extranodal extension
N3: Metastasis in a lymph node, > 6 cm in greatest dimension and no extranodal extension; or metastasis in any nodes with clinically overt with extranodal extension
Metastasis classification
M0: No distant metastasis
M1: Distant metastasis present
Stage cannot be fully assessed
Create free account

Diagnostic investigations

History and physical examination: as per AAO-HNSF 2017 guidelines, elicit an initial history and perform a physical examination in adult patients with a neck mass to identify suspicious findings representing an increased risk for malignancy.
B
Show 4 more

More topics in this section

  • Diagnostic imaging

Diagnostic procedures

Biopsy and pathology: as per ESMO/EURACAN 2022 guidelines, obtain pathological confirmation of the salivary gland tumor.
B
Show 5 more

More topics in this section

  • Ancillary testing

Medical management

Adjuvant chemotherapy: as per ESMO/EURACAN 2022 guidelines, insufficient evidence to recommend adding chemotherapy to postoperative radiotherapy of the primary tumor and neck.
I

More topics in this section

  • Definitive chemotherapy

Therapeutic procedures

Adjuvant radiotherapy
As per ESMO/EURACAN 2022 guidelines:
Offer postoperative local radiotherapy in patients with T3-T4 and intermediate/high-grade tumors and in cases with close resection margins (1-5 mm; 30×2 Gy), incomplete resection margins (33×2 Gy), or perineural growth.
B
Offer postoperative regional radiotherapy in cases with pN+ (30×2 Gy) and extranodal extension (33×2 Gy). Offer unilateral elective neck irradiation (25×2 Gy) based on the inclusion criteria for elective neck dissection.
B

More topics in this section

  • Definitive radiotherapy

  • Technical considerations for radiotherapy

Surgical interventions

General principles
As per ESMO/EURACAN 2022 guidelines:
Collect as much information as possible about the tumor before surgery, discuss scenarios with the patient, and be prepared for doing a graft during the ablative procedure.
B
Consider performing intraoperative frozen sections to evaluate margins of resection, perineural invasion, and lymph nodes, but only if the result is expected to alter management at the time of surgery.
C

More topics in this section

  • Parotid gland resection

  • Facial nerve preservation

  • Submandibular gland resection

  • Management of regional lymph nodes

Follow-up and surveillance

Follow-up, clinical assessment
As per ASCO 2021 guidelines:
Obtain clinical follow-up with history and physical examination regularly with decreasing frequency as the time elapses from completion of treatment of SGC.
B
Obtain long-term follow-up (beyond 5 years) with an annual examination in all patients with SGC.
B

More topics in this section

  • Follow-up (imaging assessment)

  • Management of recurrent locoregional disease

  • Management of recurrent metastatic disease

  • Survivorship and rehabilitation (general principles)

  • Survivorship and rehabilitation (lifestyle modifications)

  • Survivorship and rehabilitation (neuromuscular complications)

  • Survivorship and rehabilitation (neurosensory complications)

  • Survivorship and rehabilitation (speech disturbance)

  • Survivorship and rehabilitation (oral and dental care)

  • Survivorship and rehabilitation (gastroesophageal complications)

  • Survivorship and rehabilitation (thyroid dysfunction)

  • Survivorship and rehabilitation (lymphedema)

  • Survivorship and rehabilitation (fatigue)

  • Survivorship and rehabilitation (sleep disorders)

  • Survivorship and rehabilitation (psychosocial distress)