Workup/Staging

Question 1

What is the most common presentation of parotid gland tumors?

Answer 1

A painless, solitary mass is the most common presentation of parotid gland tumors.

Question 2

For what does a painful growth/mass in the salivary gland predict?

Answer 2

It predicts for malignancy or an inflammatory etiology/condition.

Question 3

What are some other presenting Sx in pts with salivary gland tumors?

Answer 3

Pain, facial weakness from CN VII involvement, rapid growth of mass, skin involvement, neck nodes. Sensory changes of the face can occur from involvement of the trigeminal nerve branches (CN V), and dysarthria/dysphagia can occur from CN XII being affected.

Question 4

What is the DDx for a parotid mass?

Answer 4

Primary tumor, mets, lymphoma, parotitis, sarcoid, cyst, Sjögren syndrome, stone, lipoma, hemangioma

Question 5

What are the 2 most important factors that predict for nodal mets in salivary gland malignancies?

Answer 5

Grade and size are the 2 most important factors that predict for nodal mets: high grade (50%) vs. intermediate/low grade (<10%) and size (>4 cm: 20% vs. <4 cm: 4%).

Question 6

What is the typical workup performed for salivary gland tumors?

Answer 6

Salivary gland tumor workup: H&P (CNs/nodes), CBC, CMP, CXR, CT/MRI H&N, and FNA Bx

Question 7

How should Bx be obtained for pts who present with a salivary gland mass?

Answer 7

Some argue that a salivary gland mass should be removed regardless, so do not Bx. However, FNA should be done (despite an FN rate of 20%), as knowledge of the histology may impact the type of Sg.

Question 8

What is the T-staging breakdown for major salivary gland tumors (AJCC 8th edition)?

Answer 8

T1: ≤2 cm no extraparenchymal extension (ST invasion, clinical/macroscopic)

T2: >2 cm, ≤4 cm, no extraparenchymal extension

T3: >4 cm and/or extraparenchymal extension

T4(a–b): local invasion of adjacent structures (see below)

Question 9

What is the distinction b/t T4a vs. T4b major salivary gland tumors?

Answer 9

T4a: usually still resectable; skin, mandible, ear, facial nerve invasion

T4b: usually unresectable; skull base, pterygoid plate, carotid artery encasement

Question 10

What is the clinical nodal staging system used for major salivary gland tumors?

Answer 10

The same as most H&N sites (except for NPX and p16+ OPX):

N1: single ipsi, ≤3 cm, ENE(–)

N2a: single ipsi, >3 cm, ≤6 cm, ENE(–)

N2b: multiple ipsi, ≤6 cm, ENE(–)

N2c: any bilat or contralat, ≤6 cm, ENE(–)

N3a: any >6 cm, ENE(–)

N3b: any clinically overt ENE(+)

Question 11

What is the pathologic nodal staging system used for major salivary gland tumors?

Answer 11

The same as most H&N sites (except for NPX and p16+ OPX):

N1: single ipsi, ≤3 cm, ENE(–)

N2a: single ipsi/contra ≤3 cm, ENE(+) OR single ipsi >3 cm, ≤6 cm, ENE(–)

N2b: multiple ipsi, ≤6 cm, ENE(–)

N2c: any bilat or contralat, ≤6 cm, ENE(–)

N3a: any >6 cm, ENE(–)

N3b: any ENE(+) besides N2a

Question 12

Per the latest AJCC 8th (2017) edition classification, what are the stage groupings for major salivary gland tumors?

Answer 12

Stage I: T1N0

Stage II: T2N0

Stage III: T3N0 or T1–3N1

Stage IVA: T4aN0–1 or T1–4aN2

Stage IVB: T4b any N or any T N3

Stage IVC: M1

Question 13

On what is the staging system for the minor salivary gland tumors based?

Answer 13

Staging of the minor salivary gland tumors is based on the site of origin.

Question 14

What are some important prognostic factors in salivary gland tumors?

Answer 14

Size, grade, histology, nodal status, and “named” nerve involvement are important prognostic factors.

Question 15

What is the 5-yr OS for stages I–IV cancers of the salivary gland?

Answer 15

Stage I: 80%

Stage II: 60%

Stage III: 50%

Stage IV: 30%

Question 16

What is the 5-yr OS of pts who present with facial nerve involvement?

Answer 16

The 5-yr OS is 65% with simple invasion and 10% if pts have nerve dysfunction (i.e., if symptomatic).