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

  • HeadandNeckCancerGuide.org. Salivary Gland Cancer Tumor Grade. 2018.
  • Deschler DG, Emerick KS, Wirth LJ, Busse PM . Management of salivary gland tumors: general principles and management. Harrison LB, Sessions RB, Kies MS (eds.). Head and Neck Cancer: A Multidisciplinary Approach. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014: 25(A): 697-724.
  • Locati LD, Guzzo M, Orlandi E, Licitra L . Management of salivary gland cancer. Bernier J (ed.). Head and Neck Cancer: Multimodality Management. Springer; 2016: 36:625-640.