This page includes the following sections:
Clicking on one of the headings will jump you down to that section of page.
This page of our website is devoted to Cancer
“Staging” and “Grading”, and specifically Staging
and Grading of Acinic Cell Carcinoma and Salivary Gland Cancers. Staging
and Grading are shorthand methods of describing disease. They are used
by the medical community to categorize tumor(s) and extent of disease
in a patient, as well as to provide information on the potential for growth
and spread of that disease.
STAGE refers to the extent of cancer within the patient, including
whether the disease has spread from the original site to other parts of
the body.
STAGING refers to the determination of the extent of cancer.
GRADE (of a tumor) is determined by how abnormal the cancer cells
appear when examined under a microscope, the probable growth rate of the
tumor, and its tendency to spread. Low-grade cancers grow more slowly
than high-grade cancers. Most acinic cell carcinomas are “low grade”,
but not all.
GRADING is a system for classifying cancer cells as described above.
The objective of a grading system is to provide information about the
probable growth rate of the tumor and its tendency to spread. The systems
used to grade tumors vary with each type of cancer.
Both STAGE and GRADE play a role in treatment decisions and recommendations.
Physicians routinely use these classifications to get a quick overview
of a patient’s case.
The distinction is sometimes also made between “pathological”
and “clinical” stage (the former determined by examination of
tumor slides, the latter determined by patient condition). Classification
by “combined stage” reflects pathologic data when it is available,
and clinical stage when it is not.
Another classification called “Summary Staging” has also
been created, and is being used by the National Program of Cancer Registries
in the United States. It is also referred to as “General Staging”,
“California Staging”, and “SEER Staging”. Summary
staging uses all information available in the medical record; in other
words, it is a combination of the clinical and pathological documentation.
Summary staging is based on the theory of cancer growth. It uses descriptive
words instead of abbreviations. Even though summary staging is used frequently
in cancer registries, it has not been widely utilized by physicians. Physicians
are more likely to use the AJCC TNM staging system.
Currently, The American Joint Committee on Cancer (AJCC) “TNM” system is the most common method for staging salivary gland cancers. That (and other systems) are presented in more detail in the citations later on this page. Explanations of the current abbreviations and their meaning (within the AJCC system) are given. So you will be able to read medical records describing your tumor/disease/case and understand what the specific abbreviations of stage and grade mean.
For Patients: A couple generalities that may answer your basic questions:
- Low Grade is less serious than High Grade.
- Stage I disease is less serious than Stage IV (in the AJCC system).
However, it is important to note that many people have had Stage 4
ACC, and survived many many years (that includes the creator of this website).
There have been different Staging and Grading classification systems over
the years, and also from different geographic locations. There have also
been revisions and changes within the same systems. And there has been
ongoing disagreement within
the medical community about specific criteria for classification, especially
with regard to the grading of certain tumors. All of these factors have
led to variations and inconsistencies in the literature, as well as in
treatment decisions. That is the main reason for devoting an entire page
of this website to this subject.
The lack of consistent and standardized staging and grading can lead to
unreliable data and statistics. It also has the potential to lead to questionable
treatment choices, based on questionable tumor grade classifications.
(Grade classification affects predicted disease progression/prognosis.)
These points are discussed in the enclosed literature on this page as
well.
Specific information on the discrepancies in categorizing Acinic Cell
Carcinoma are also presented. The association between tumor grade and
biologic behavior for this cancer has remained controversial. However,
it is our opinion (based on the literature and our experiences) that there
is a clear correlation between high grade and aggressive behavior in this
cancer. That should absolutely be taken into consideration in treatment
decisions.
We have provided a selected amount of relevant information on this Staging
and Grading subject. First we provide some general Definitions, then some
Overviews, and finally a list of Citations which delve into the subject
in more detail. We hope that the material we have chosen will help you
to understand this area more clearly. Citations are listed in reverse
chronological order, with most recent publications first. They are not
listed in order of importance. A magnifying glass symbol next to a citation
is one we find more valuable or informative.
We wish to remind readers that the material provided here is for educational purposes, and not a substitute for professional health care. ACCIC overviews are opinions written by a well-informed cancer patient. As such.they are lay-person opinions, not professional medical advice.
Cancer.gov (Natl. Cancer
Institute) Dictionary:
http://www.cancer.gov/dictionary/
grade
The grade of a tumor depends on how abnormal the cancer cells look under
a microscope and how quickly the tumor is likely to grow and spread. Grading
systems are different for each type of cancer.
grading
A system for classifying cancer cells in terms of how abnormal they appear
when examined under a microscope. The objective of a grading system is
to provide information about the probable growth rate of the tumor and
its tendency to spread. The systems used to grade tumors vary with each
type of cancer. Grading plays a role in treatment decisions.
stage
The extent of a cancer within the body, especially whether the disease
has spread from the original site to other parts of the body.
staging
Performing exams and tests to learn the extent of the cancer within the
body, especially whether the disease has spread from the original site
to other parts of the body. It is important to know the stage of the disease
in order to plan the best treatment.
stage I breast cancer
Cancer no bigger than 2 centimeters (about 1 inch) that has not spread
outside the breast.
stage II breast cancer
Stage II breast cancer means one of the following: cancer is no larger
than 2 centimeters but has spread to the lymph nodes in the armpit (the
axillary lymph nodes); cancer is between 2 and 5 centimeters (1 to 2 inches)
and may have spread to the lymph nodes in the armpit; cancer is larger
than 5 centimeters (2 inches) but has not spread to the lymph nodes in
the armpit.
stage III breast cancer
Stage III is divided into stages IIIA and IIIB. In stage IIIA breast cancer,
the cancer (1) is smaller than 5 centimeters (2 inches) and has spread
to the lymph nodes in the armpit, which have grown into each other or
into other structures and are attached to them; or (2) is larger than
5 centimeters and has spread to the lymph nodes in the armpit. In stage
IIIB breast cancer, the cancer (1) has spread to tissues near the breast
(skin, chest wall, including the ribs and the muscles in the chest); or
(2) has spread to lymph nodes inside the chest wall along the breast bone.
stage IIIA breast cancer
Stage IIIA breast cancer is defined by either of the following: (1) the
cancer is smaller than 5 centimeters (2 inches) and has spread to the
lymph nodes under the arm, which have grown into each other or into other
structures and are attached to them; (2) the cancer is larger than 5 centimeters
and has spread to the lymph nodes under the arm.
stage IIIB breast cancer
Stage IIIB breast cancer is defined by either of the following: (1) the
cancer has spread to tissues near the breast (skin, chest wall, including
the ribs and the muscles in the chest); (2) the cancer has spread to lymph
nodes inside the chest wall along the breast bone.
stage IV breast cancer
Cancer has spread to other organs of the body, most often the bones, lungs,
liver, or brain; or tumor has spread locally to the skin and lymph nodes
inside the neck, near the collarbone.
stage I pancreatic cancer
Cancer that is found only in the pancreas itself or has started to spread
to the tissues next to the pancreas (such as the small intestine, the
stomach, or the bile duct).
stage II pancreatic cancer
Cancer that has spread to nearby organs such as the stomach, spleen, or
colon but has not entered the lymph nodes.
stage III pancreatic cancer
Cancer of the pancreas in which the cancer has spread to the lymph nodes
near the pancreas. Cancer may have spread to nearby organs.
stage IV pancreatic cancer
Cancer of the pancreas in which the cancer has spread to organs near the
pancreas (stage IVA) or to organs far away from the pancreas (stage IVB).
stage IVA pancreatic cancer
Cancer has spread to organs that are near the pancreas (such as the stomach,
spleen, or colon) but has not spread to distant organs (such as the liver
or lungs).
stage IVB pancreatic cancer
Cancer of the pancreas in which the cancer has spread to distant organs
(such as the liver or lungs).
CancerWEB Online Medical Dictionary:
http://cancerweb.ncl.ac.uk/omd/
stage
<oncology> The extent to which cancer has spread from its original
site to other parts of the body. Usually denoted by a number from Stage
1 (least severe) to Stage 4 (more advanced). Different lymphoma types
have different criteria for staging.
staging
Staging of breast cancer is based on the TNM Classification which classifies
the size, site and spread of the disease.Therapeutic decisions are formulated
in part according to staging (they are formulated primarily according
to lymph node status and ER and PR receptor levels in the tumourous tissue,
refer definition of ER and PR in this dictionary). The numbers I, II,
III and IV are used to denote the stages and each number refers to a possible
combination of TNM factors. For example: a Stage I breast cancer is defined
by the TMN group: T1, N0, M0 which mean:T1 - Tumour is 2cm or less in
diameter, N0 - No regional lymph node metastasis, M0 - No distant metastasis.
A complete outline of TMN and Staging is available from PDQ, for which
refer to the resource centre's listing of information services
Acor.org Dictionary (Glossary)
http://www.acor.org/dictionary/
Grade
The grade of a tumor is determined by how abnormal the cancer cells appear
when examined under a microscope, the probable growth rate of the tumor,
and its tendency to spread. The systems used to grade tumors vary with
each type of cancer.
Grading
A system for classifying cancer cells in terms of how abnormal they appear
when examined under a microscope. The objective of a grading system is
to provide information about the probable growth rate of the tumor and
its tendency to spread. The systems used to grade tumors vary with each
type of cancer. Grading plays a role in treatment decisions.
Staging
Doing exams and tests to learn the extent of the cancer within the body,
especially whether the disease has spread from the original site to other
parts of the body.
Stage
The extent of a cancer within the body, including whether the disease
has spread from the original site to other parts of the body. Staging
refers to the determination of the extent of cancer.
GENERAL
CANCER STAGING AND GRADING OVERVIEWS
Staging
Defined
A Natl. Cancer Institute Training Module
http://training.seer.cancer.gov/module_ss2k/intro_staging_defined.html
Current as of 8/2002
Well presented overview of all aspects of staging (in general), including history, and descriptions of various staging systems.
About the AJCC Cancer Staging Manual
(from publisher)
As of 8/2002
General
descriptions of the AJCC Cancer Staging Manual, and the new 6th Edition.
AJCC Cancer Staging Manual, 6th Edition Description
http://cancerstaging.org/initiatives.html#3
As of 8/2002
Brief description of latest edition
of AJCC Cancer Staging Manual
Cancer Grading and Staging
Taber's Medical Encyclopedia
Available on Rxlist.com
http://www.rxlist.com/
2001
Short summary of cancer grading and
staging. Not very comprehensive.
Salivary
Gland Tumors – Clinical and Pathological Features
S Tabibzadeh
BioScience.org - FRONTIERS IN BIOSCIENCE; LECTURE SERIES
- Vol 3, z1-129, January 1, 1998
Dept of Pathology, Moffitt Cancer Center and University of South Florida,
12902 Magnolia Drive, Tampa, FL 33612
http://www.bioscience.org/lecture/tabibza/list.htm
(Official) Classifications of Salivary
Gland Tumors:
Foote and Frazell classify ACC as “malignant”.
Thackary and Lewis classify ACC as “malignant”.
Armed Forces Institute of Pathology classifies ACC as a “malignant
adenocarcinoma”.
ACC
OR SALIVARY GLAND CANCER -
STAGES/STAGING AND GRADES/GRADING:
Published Articles, Abstracts, Book Excerpts & Links
Salivary Gland Neoplasms
Author: Michael M. Johns, MD
Editor(s): David J Terris, MD, Fellowship Codirector, Associate Professor,
Department of Surgery, Division of Otolaryngology, Stanford University
Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor,
Pharmacy, eMedicine; Erik Kass, MD, Chief, Department of Clinical Otolaryngology,
NIH National Institute On Deafness and Other Communication Disorders;
Christopher L Slack, MD, Consulting Staff, Otolaryngology-Facial Plastic
Surgery, Lawnwood Regional Medical Center; and Arlen D Meyers, MD, MBA,
Professor, Department of Otolaryngology-Head and Neck Surgery, University
of Colorado School of Medicine
Emedicine.com
http://www.emedicine.com/ent/topic679.htm
Last Updated: July 25, 2003
Excerpts from comprehensive overview
of Salivary Gland Neoplasms. Authored by experienced otolaryngologist.
We have selected relevant STAGE and GRADE-related excerpts here. For full
article with images, go to Emedicine website (link below), or for text
only, click “Link to Full Text Only” to take you to the full
text on one of our Literature pages.
What is meant by staging or grading?
From ACCO site – Adenoid Cystic Carcinoma Organization FAQs:
http://www.orgsites.com/ca/acco/_pgg1.php3
As of 5/15/02
Short answer to FAQ from the Adenoid
Cystic Carcinoma (similar cancer) Organization website. Clear simple overview
of Salivary Gland/Adenoid Cystic staging.
AJCC Cancer Staging Manual – Sixth
Edition (2002)
American Joint Committee on Cancer
Chapter on Major Salivary Glands
Includes Acinic Cell Carcinoma
Most recent AJCC staging and grade
information on major salivary gland cancers.
This citation currently not available. Please check back.
Stage Information
Salivary Gland Cancer (PDQ®): Treatment
Patient Version
From National Cancer Institute: cancer.gov website:
http://www.cancer.gov/cancer_information/doc_pdq.aspx?version=0&summaryid=208_01455
Date Last Modified: 06/2002
Simple concise Salivary Gland Cancer
stage definitions for patients.
Stage
Information
Salivary Gland Cancer (PDQ®): Treatment
Health Professional Version
From National Cancer Institute: cancer.gov website: http://www.cancer.gov/cancer_information/doc_pdq.aspx?version=
1&summaryid=208_01455
Date Last Modified: 02/2002
Simple concise Salivary Gland Cancer
stage definitions for health professionals.
Data
Form for Cancer Classification of GRADE of Salivary Gland Tumors
Frontiers in Bioscience;
http://www.bioscience.org/atlases/tumpath/class/salivary.htm
(as of 6/2002)
Form listing cancer types and categories
that physicians use to classify GRADE of salivary cancer cases.
Data
Form for Cancer Classification of STAGE of Salivary Gland Tumors
Frontiers in Bioscience;
http://www.bioscience.org/atlases/tumpath/staging/salivary.htm
(as of 6/2002)
From: Cancer: Principles & Practice
of Oncology, 6th Editions
Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven A. Rosenberg, MD,
PhD
January 2001
Chapter 30.4: Tumors of the Salivary Glands and Paragangliomas
Roy B. Sessions, Louis B. Harrison, Arlene A. Forastiere
Major Salivary Gland Tumors
Section on: Natural History, Behavior Staging, and Treatment Principles
Considered by many in the worldwide
medical community as the standard-setting oncology reference, Cancer:
Principles and Practice of Oncology is now in its Sixth Edition. This
is the entire excerpt having to do with Staging and Grading of Major Salivary
Gland Cancers. However, it includes NOT the latest version of AJCC Staging
Manual classifications.
Excerpts
from:
What is Salivary Gland Cancer?
Cancer Reference Information
American Cancer Society website
http://www.cancer.org/eprise/main/docroot/CRI/content/CRI_2_4_
1X_What_is_salivary_gland_cancer_54
As of 2001
An overview of Salivary
Gland Cancer, written for patients. Mostly quite informative and easy
to read. Some inaccuracies within complete document, not included here.
We have excerpted relevant sections on Salivary Gland cancer grading and
staging.
Cancer Medicine, 5th Edition
Section 27: Neoplasms of the Head and Neck –
86. Head and Neck Cancer (and Salivary Gland specific) –
Staging Excerpt
Bast, Robert C.; Kufe, Donald W.; Pollock, Raphael E.; Weichselbaum,
Ralph R.; Holland, James F.; Frei, Emil, editors.
Publisher: Canada: BC Decker Inc;
Copyright 2000. [5th edition.]
http://www.ncbi.nlm.nih.gov:80/books/bv.fcgi?tool=bookshelf&call=bv.View..ShowSection&
searchterm=acinic&rid=cmed.section.d1e724352#d1e728046
Courtesy PubMed/NCBI
Relevant excerpt on Staging of Salivary
Gland Cancers, from a prominent textbook/reference for health professionals.
See more comprehensive excerpts from this book in the Salivary Gland
Cancer Treatment Overviews page, or in the Link provided.
National
Cancer Data Base Report On Cancer of the Head and Neck: ACINIC CELL
CARCINOMA
Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD,
John A. Pinkston MD, Herman R. Menck MBA.
Head and Neck – July 1999; 2 1(4):297-309
(several
excerpts from lengthy article)
Excerpts from the largest review
of Acinic Cell Carcinoma cases to date. Includes overview of some of
the problems created by inconsistencies (and revisions) in grading/staging
acinic cell carcinoma.
The development of a prognostic score
for patients with parotid carcinoma.
Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Loftus-Coll BM,
Keus RB, van Leeuwen FE, Hart AA
Cancer; 85(9):2057-67 1999
Courtesy PubMed/NCBI
Article proposing a new subgrouping
for parotid carcinomas, based on the combined effects of key prognostic
preoperative and postoperative factors.
Major salivary glands (parotid, submandibular, and sublingual).
In: American Joint Committee on Cancer: AJCC Cancer Staging Manual.
Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997,
pp 53-58.
VIEW ABSTRACT VIEW
FULL TEXT
(currently neither version available here)
Table of Staging System for Major Salivary
Gland Malignancies
American Joint Committee on Cancer: AJCC Cancer Staging Manual.
Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997
The standard StagingTable for Major
Salivary Gland Malignancies, as of 1997. A standard source for physicians,
but not the most recent version. However, THIS version is reprinted
in Cancer: Principles & Practice of Oncology, 6th Editions copyright
January 2001(Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven
A. Rosenberg, MD, PhD) This reference book is considered by most of
the worldwide medical community as the standard-setting oncology reference.
There is a more recent staging manual, WITH some changes (elsewhere
on this Stage/Grade page), but many doctors will use the 1997 version,
due to its’ inclusion in that publication.
[Diagnosis and prognosis of salivary gland
tumors. An interpretation of new revised WHO classification]
[Article in German]
Seifert G.
Institut fur Pathologie Universitat Hamburg.
Mund Kiefer Gesichtschir 1997 Sep;1(5):252-67
Courtesy PubMed/NCBI
The classification of salivary gland
tumors, especially in relation to revised WHO classification (1997)
is concisely examined. Full text is in German.
Stage means more than
grade in adenoid cystic carcinoma.
Spiro RH, Huvos AG.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
New York.
Am J Surg. 1992 Dec;164(6):623-8.
184 previously untreated cases of adenoid
cystic carcinoma of salivary gland origin are reviewed at Memorial Sloan
Kettering. Only the clinical stage had a significant impact on survival.
Neither survival, regional metastases, nor distant dissemination was predictable
on the basis of tumor grade alone.
Histopathologic grading of salivary gland neoplasms: II. Acinic cell
carcinomas.
Batsakis JG, Luna MA, el-Naggar AK.
Dept of Pathology, University of Texas M. D. Anderson Cancer Center, Houston
77030.
Ann Otol Rhinol Laryngol 1990 Nov;99(11):929-33
Courtesy PubMed/NCBI
Proposal to grade acinic cell carcinomas
and identify more and less aggressive subsets. A three-level histolopahologic
grading scheme is presented.
Clinical staging system for cancer of the
salivary gland: a retrospective study.
Levitt SH, McHugh RB, Gomez-Marin O, Hyams VJ, Soule EH, Strong EW, Sellers
AH, Woods JE, Guillamondegui OM
Cancer; 47(11):2712-24, 1981
No abstract currently available.