Salivary malignant tumors Flashcards
What is the most common salivary gland malignancy in children?
Mucoepidermoid carcinoma
True or False. A history of radiation therapy to the head and neck is a risk factor for future development of salivary gland tumors.
True. A history of radiation therapy at any age and any dose increases the risk for development of salivary gland tumors.
List the risk factors associated with salivary gland
cancer.
Previous radiation exposure, history of head and neck skin
cancer, Epstein-Barr virus, HIV infection, Hodgkin disease,
industrial exposure to rubber manufacturing or nickel compound, or employment in a beauty salon are risk
factors.
What are clinical signs and symptoms of salivary gland malignancy?
Pain, fixed lesion, invasion of overlying skin, rapidly growing
mass, facial nerve palsy, and cervical lymphadenopathy
True or false. In general, the best radiologic study
to evaluate a malignant salivary gland mass is CT
with contrast.
False. Although CT provides useful information, MRI is the
preferred imaging modality for parotid gland lesions. MRI
provides superior detail regarding invasion of surrounding
structures and type of pathology.
True or False. FNA biopsy of salivary gland malignancies has high sensitivity but low specificity.
False. The sensitivity is fairly low, whereas the specificity is
quoted to be greater than 90% in most studies.
Define the T stages for the Tumor, Node, Metastasis (TNM) classification for major salivary gland malignancies.
T1 ≤ 2 cm
T2 > 2 cm and ≤ 4 cm
T3 ≥ 4 cm and/or extraparenchymal extension
T4a Invades skin, mandible, ear canal, or facial nerve
T4b Invades skull base, pterygoid plates, or encases carotid artery
Data from Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual 7th Edition. New
York, NY: Springer; 2010.
Define the N stages for the TNM classification for major salivary gland malignancies.
● Nx: Regional lymph nodes cannot be assessed.
● N0: No regional lymph nodes
● N1: Single ipsilateral node, 3 cm or smaller
● N2a: Single ipsilateral node 3 to 6 cm in diameter
● N2b: Multiple ipsilateral nodes; none larger than 6 cm
● N2c: Bilateral or contralateral nodes, none larger than
6 cm
● N3: Any lymph node larger than 6 cm in diameter
Define the overall staging (I through IV) for major salivary gland malignancies.
● Stage I: T1N0M0 ● Stage II: T2N0M0 ● Stage III: T3N0M0 or T1–3N1M0 ● Stage IVA: T1–3N2M0 or T4aN0–2M0 ● Stage IVB: T4bN1–3M0 or T1–4N3M0 ● Stage IVC: M1
What is the incidence of malignancy in tumors of
the major salivary glands?
About 15 to 32% of parotid tumors are malignant, 41 to
45% of submandibular tumors are malignant, and 70 to 90%
of sublingual gland tumors are malignant.
What is the incidence of cervical lymph node
metastasis in a primary submandibular neoplasm?
30%
What is the most common histologic subtype of
malignant salivary gland tumors?
Mucoepidermoid carcinoma is the most common malig-
nant salivary gland tumor, followed by adenoid cystic
carcinoma, and then adenocarcinoma.
Grading of mucoepidermoid carcinoma is critical
to prognosis and management. What is the histologic appearance of low-grade mucoepidermoid carcinoma?
Low-grade mucoepidermoid carcinoma is more cystic with little atypia and low mitotic activity. High grade is more solid.
What is the prognosis of mucoepidermoid carcinoma?
Patients with low-grade and intermediate-grade carcinoma with no regional or distant metastases have an excellent prognosis, with 5-year survival greater than 90%. High-grade tumors have a lower 5-year survival of around 50%.
What is the recommended treatment for low-
grade and high-grade mucoepidermoid carcinoma?
Low-grade carcinoma requires removal of the salivary gland
with a margin of healthy tissue, but elective neck dissection
is not necessarily required. High-grade carcinoma requires total excision and elective or therapeutic neck dissection and often adjuvant radiation.