Grading salivary gland cancer

Grading describes how the cancer cells look compared to normal, healthy cells. Knowing the grade gives your healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread. This helps them plan your treatment. The grade can also help the healthcare team predict future outcomes (your prognosis) and how the cancer might respond to treatment.

To find out the grade of salivary gland cancer, a pathologist looks at a tissue sample from the tumour under a microscope. They look at how different the cells look from normal cells (called differentiation) and other features of the tumour such as the size and shape of the cells and how the cells are arranged. They can usually tell how fast a tumour is growing by looking at how many cells are dividing.

The pathologist grades salivary gland cancer from low grade to high grade. They may also use numbers from 1 to 3 to describe a grade.

Low-grade or grade 1 tumours have cancer cells that are well differentiated. The cells are abnormal but look a lot like normal cells and are arranged a lot like normal cells. Lower grade cancers tend to grow slowly and are less likely to spread.

Intermediate-grade or grade 2 tumours have cancer cells that are moderately differentiated. The cells are more abnormal than low grade cancers, but not as abnormal as high grade tumours.

High-grade or grade 3 tumours have cancer cells that are poorly differentiated or undifferentiated. The cells don't look like normal cells and are arranged very differently. Higher grade cancers tend to grow more quickly and are more likely to spread than low-grade cancers.

Knowing the grade is most important for these types of salivary gland tumours, as they can be any grade:

  • mucoepidermoid carcinoma (MEC)
  • adenoid cystic carcinoma
  • squamous cell carcinoma (SCC)
  • adenocarcinoma not otherwise specified (NOS)

Most other types of salivary gland tumours are always either low grade or high grade.

Expert review and references

  • American Cancer Society. Salivary Gland Cancer. American Cancer Society; 2014: http://www.cancer.org/cancer/salivaryglandcancer/index.
  • Bar-Ad V, Tuluc M, Cognetti D & Axelrod R . Uncommon tumors of the oral cavity and adjacent structures. Raghavan D, Blanke CD, Honson DH, et al. (eds.). Textbook of Uncommon Cancer. 4th ed. Wiley Blackwell; 2012: 6:pp. 97-117.
  • Garden, A. S . Salivary gland cancer. Gospodarowicz, M. K., O'Sullivan, B., Sobin, L. H., et al. (Eds.). Prognostic Factors in Cancer. 3rd ed. Hoboken, NJ: John Wiley & Sons, Inc; 2006: 10:pp. 113-117.
  • Mendenhall WM, Werning JW and Pfister DG . Treatment of head and neck cancer. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 72:729-80.
  • National Cancer Institute. Salivary Gland Cancer Treatment (PDQ®) Health Professional Version. 2014.
  • Terhaard CHJ . Salivary gland cancer. Halperin EC, Wazer DE, Perez CA et al. Perez and Brady's Principles and Practice of Radiation Oncology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.