Salivary gland tumor

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Salivary gland tumor is a tumor that forms in the tissues of a salivary gland. The salivary glands are classified as major and minor. The major salivary glands consist of the parotid, submandibular, and sublingual glands. The minor glands include small mucus-secreting glands located throughout the palate, nasal, and oral cavity.^[1] Malignant salivary gland neoplasms account for approximately 0.5% of all malignancies and approximately 3% to 5% of all head and neck tumors.^[2] Salivary gland tumor may be classified according to the World Health Organization into five groups: malignant epithelial tumors, benign epithelial tumors, soft tissue tumors, hematolymphoid tumors, and secondary tumors.^[1] The pathophysiology of salivary gland tumors depends on the histological subtype.^[3] There are no established causes of salivary gland tumors. The incidence of salivary gland tumors is approximately 2.5 to 3.0 individuals per 100,000 individuals worldwide. The incidence of salivary gland tumors is estimated to be 2000 to 2500 cases per year in the United States. The incidence of salivary gland tumors increases with age; the median age at diagnosis is 64 years. Salivary gland tumors are more common in males than females. There is no racial predilection to the salivary gland tumors.^[2] Common risk factors in the development of salivary gland tumors are age, radiation exposure, environment and occupational exposure, certain viruses, male gender, smoking, and family history.^[4] Symptoms of salivary gland tumor includes difficulty swallowing, muscle weakness on one side of the face, a lump or swelling on or near the jaw or in the neck or mouth, numbness in part of the face, persistent pain in the area of a salivary gland, and trouble opening the mouth widely. The optimal therapy for salivary gland tumors depends on the stage at diagnosis. The mainstay of therapy for salivary gland tumors is surgery. External beam radiation therapy may be used following surgery, when surgery is not possible, or would cause significant complications. Chemotherapy is considered when radiation therapy or surgery is not possible.

Salivary gland tumor may be classified according to the World Health Organization into five groups: malignant epithelial tumors, benign epithelial tumors, soft tissue tumors, hematolymphoid tumors, and secondary tumors.^[1]

The pathophysiology of salivary gland tumors depends on the histological subtype.^[3]

There are no established causes of salivary gland tumors.

Salivary gland tumor must be differentiated from other diseases that cause a salivary gland mass or enlargement such as salivary cysts, cysts of the first branchial cleft, salivary gland stones, sarcoid infiltration of the parotid gland, Sjogren’s syndrome, metastasis from other tumors, lymphoepithelial cysts, chronic sclerosing sialadenitis, regional lymphadenopathy, Bell’s palsy, and intraparotid facial nerve schwannoma.^[5][6]

The incidence of salivary gland tumors is approximately 2.5 to 3.0 cases per 100,000 individuals worldwide. The incidence of salivary gland tumors is estimated to be 2000 to 2500 cases per year in the United States. The incidence of salivary gland tumors increases with age; the median age at diagnosis is 64 years. Salivary gland tumors are more common in males than females. There is no racial predilection to the salivary gland tumors.^[2]

Common risk factors in the development of salivary gland tumors are age, radiation exposure, environment and occupational exposure, certain viruses, male gender, smoking, and family history.^[4]

According to the United States Preventive Services Task Force, screening for salivary gland tumors is not recommended.^[7]

If left untreated, patients with salivary gland tumors may progress to develop metastasis. Common complications of salivary gland tumors include metastasis, injury to the facial nerve, and Frey’s syndrome. Prognosis is generally good, and the 5 year mortality rate of patients with salivary gland cancer that has not spread at the time of diagnosis is 91%.^[2][8]

According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of salivary gland cancers based on the tumor size, lymph nodes involved, and metastasis.^[2]

Symptoms of salivary gland tumor includes dysphagia, muscle weakness on one side of the face, a lump or swelling on or near the jaw or in the neck or mouth, numbness in part of the face, persistent pain in the area of a salivary gland, and trouble opening the mouth widely.^[2][4]

Common physical examination findings of salivary gland cancer include painless, firm swelling in one of the salivary gland, cervical lymphadenopathy, dysphagia, trouble opening the mouth widely, difficulty moving one side of the face and muscle weakness on one side of the face suggestive of cranial nerve VII deficit, loss of corneal reflex, localized or regional pain, numbness, paresthesia, causalgia, or a loss of motor function suggestive of cranial nerve V deficit.^[4]

There are no established lab findings associated with salivary gland tumors.

Biopsy of the tumor tissue is diagnostic of salivary gland tumor.^[1][2]

X-rays of jaw and teeth may be helpful in the diagnosis of salivary gland tumor.

Head and neck CT scan may be diagnostic of salivary gland tumors. Findings on CT scan suggestive of salivary gland tumors include bony, local and, perineural invasion, and lymph node metastasis.^[9][10]

Head and neck MRI may be diagnostic of salivary gland tumors. Findings on head and neck MRI suggestive of salivary gland tumors include soft tissue infiltration, perineural invasion, and intracranial extention.^[4]

Ultrasound may be helpful in the diagnosis of salivary gland tumors. Findings on ultrasound suggestive of salivary gland tumors typically includes hypoechoic mass with lobulated distinct border with or without posterior acoustic enhancement. Ultrasound is also useful in guiding biopsy including FNAC and core biopsies.^[11]

Other imaging studies for salivary gland tumor include PET scan and endoscopy.^[4]

There are no other diagnostic studies associated with salivary gland tumors.

The optimal therapy for salivary gland tumors depends on the stage at diagnosis. The mainstay of therapy for salivary gland tumors is surgery. External beam radiation therapy may be used following surgery, when surgery is not possible (e.g. high risk of complication). Chemotherapy is considered when radiation therapy or surgery is not possible.^[2][4]

The mainstay of therapy for salivary gland tumor is surgery.^[2][4]

Effective measures for the primary prevention of salivary gland tumors include avoiding some of the possible risk factors such as tobacco, and excess alcohol use.

Secondary prevention strategies following salivary gland cancer include follow-up visits every 6-8 weeks for the first year, every 2-3 months in the second year, every 3-4 months in the third year, and then every 6-12 months for life.^[4]

Template:WikiDoc Sources

Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Salivary gland tumor may be classified according to the World Health Organization into five groups: malignant epithelial tumors, benign epithelial tumors, soft tissue tumors, hematolymphoid tumors, and secondary tumors.^[1]

Due to diverse nature of salivary gland neoplasms, many different terms and classification systems have been used. The World Health Organization in 2004, classified salivary neoplasms as primary or secondary, benign or malignant, and also by tissue of origin. This system defines five broad categories of salivary gland neoplasms:^[1]

• Acinic cell carcinoma
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Polymorphous low-grade adenocarcinoma
• Epithelial–myoepithelial carcinoma
• Clear cell carcinoma, not otherwise specified
• Basal cell adenocarcinoma
• Sebaceous carcinoma
• Sebaceous lymphadenocarcinoma

• Cystadenocarcinoma
• Low-grade cribriform cystadenocarcinoma
• Mucinous adenocarcinoma
• Oncocytic carcinoma
• Salivary duct carcinoma
• Salivary duct carcinoma, not otherwise specified
• Adenocarcinoma, not otherwise specified
• Myoepithelial carcinoma
• Carcinoma ex pleomorphic adenoma
• Carcinosarcoma
• Metastasizing pleomorphic adenoma
• Squamous cell carcinoma
• Large cell carcinoma
• Lymphoepithelial carcinoma
• Sialoblastoma

• Pleomorphic adenoma
• Myoepithelioma
• Basal cell adenoma
• Warthin’s tumor
• Oncocytoma
• Canalicular adenoma
• Lymphadenoma
• Sebaceous lymphadenoma
• Nonsebaceous lymphadenoma
• Ductal papilloma
• Inverted ductal papilloma
• Intraductal papilloma
• Sialadenoma papilliferum
• Cystadenoma

• Hemangioma

• Hodgkin lymphoma
• Diffuse large B-cell lymphoma
• Extranodal marginal zone B cell lymphoma

Secondary tumor is a tumor which has metastasized to the salivary gland from a distant location.

• Intraosseous (central) salivary gland tumors
• Hybrid tumors

Hybrid tumor is a tumor displaying combined forms of histologic tumor types.

• Hybrid carcinoma
• Others

• Others
  • Keratocystoma
  • Sialolipoma

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

The pathophysiology of salivary gland tumors depends on the histological subtype.^[1]

The parotid gland is the most frequent site of salivary gland tumors which accounts for approximately 80 to 85 percent of these tumors.^[2][3] About 75 percent of parotid lesions are benign and approximately 25 percent are malignant.^[4] Less frequently, salivary gland tumors originate in the sublingual, submandibular, and minor salivary glands, which are located throughout the submucosa of the upper aerodigestive tract and mouth.^[5]

• In comparison to tumors arising in the parotid, 70 to 90 percent of sublingual gland tumors, 50 to 75 percent of minor salivary gland tumors, and 40 to 45 percent of submandibular gland tumors are malignant. Approximately 85% of salivary gland tumors occur in the parotid glands, followed by the minor salivary glands and submandibular, and approximately 1% occur in the sublingual glands. Overall approximately 80% of all parotid masses are benign.^[6]

• Histologically, pleomorphic adenoma is the most common type of benign salivary gland tumor, which comprises about half of all salivary tumors. Other rarer benign salivary gland tumors include basal cell adenoma, Warthin’s tumor, and canalicular adenoma. The most common malignant salivary gland tumors are adenoid cystic carcinoma and mucoepidermoid carcinoma, which together constitute approximately one-half of all malignant salivary gland tumors.

Tabular form – adapted from Libre Pathology^[1]

Entity	Architecture	Morphology	Cell borders	Cytoplasm	Nucleus	Other
Pleomorphic adenoma	Variable	Mixed proportion; must include: Myoepithelium Mesenchymal stroma Epithelium (ductal cells) or Chondromyxoid stroma	Variable	Variable	Plasmacytoid	Occasionally encapsulated, mixed proportion of glandular, myoepithelial and mesenchymal cells
Warthin tumor	Papillary, bilayer	Cuboid (basal), columnar (apical)	Clearly seen	Eosinophilic, abundant	Unremarkable	AKA papillary cystadenoma lymphomatosum
Basal cell adenoma	Variable, islands surrounded by hyaline bands, lesion encapsulated	Basaloid	Subtle	Scant, hyperchromatic	Granular
Canalicular adenoma	Chains of cells	Cuboid or columnar	Subtle	Scant, hyperchromatic	Granular	Exclusively oral cavity, 80% in upper lip; immunohistochemistry: p63-
Sialoblastoma	Variable, islands surrounded by loose fibrous stroma	Basaloid	Subtle	Scant, hyperchromatic	Granular	Basal cell adenocarcinoma

Tabular form – adapted from Libre Pathology^[1]

Entity	Architecture	Morphology	Cell borders	Cytoplasm	Nucleus	Other
Mucoepidermoid carcinoma	Cystic and solid	Epitheloid	Distinct	Fuffy, clear, abundant	Nuclei small	Immunohistochemistry: p63+
Adenoid cystic carcinoma (AdCC)	Pseudocysts, cribriform, solid, hyaline stroma	Epitheloid	Subtle	Scant, hyperchromatic	Small+/-“carrot-shaped”	Stains: PAS+ (pseudocyst material), CD117+, cyclin D1+
Acinic cell carcinoma (AcCC)	Sheets, acinar (islands)	Epithelioid	Clear	Granular abundant	Stippled, +/-occasional nucleoli	Stains: PAS +ve, PAS-D +ve; Immunohistochemistry: S-100 -ve, p63 -ve
Salivary duct carcinoma	Glandular, cribriform	Columnar	Subtle/clear	Hyperchromatic	Columnar	Similar to ductal breast carcinoma; male>female
Polymorphous low-grade adenocarcinoma	Variable, often small nests, may be targetoid	Epithelioid	Indistinct	Eosinophilic	Ovoid & small with small nucleoli	Minor salivary gland tumour, often in palate, cytologically monotonous; IHC: S-100+, CK+, vim.+, GFAP+/-, BCL2+/-
Epithelial-myoepithelial carcinoma	Nests (myoepithelial) with tubules (epithelial)	Epithelioid	Not distinct	Eosinophilic cytoplasm; epithelial: scant; myoepithelial: moderate	Focal clearing	Rare
Basal cell adenocarcinoma	Variable, islands surrounded by hyaline bands, lesion not encapsulated	Basaloid	Subtle	Scant, hyperchromatic	Granular	Rare, usually parotid gland, may arise from a basal cell adenoma

• Grading is a way of classifying salivary cancer cells based on their appearance and behavior when viewed under a microscope. To find out the grade of a tumor, the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells (differentiation). This can give the healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread.^[7] The grade of salivary gland cancer is based on the degree of differentiation of cells and their rate of growth.

Grade	Description
low	Well differentiated – slow growing, less likely to spread
Intermediate	Moderately well-differentiated
High	poorly differentiated – tend to grow quickly, more likely to spread

• Grading for salivary gland cancers is used mainly for mucoepidermoid carcinomas, adenocarcinomas, adenocarcinoma NOS, squamous cell carcinomas and adenoid cystic carcinomas. Other salivary gland cancers can also be graded in the same way. Grading plays an important part in planning salivary gland cancer treatment and can also be used to help estimate the prognosis. However, the grade is not the only factor used to predict the future outcome.
• It must be considered together with staging information. Staging, in particular tumor size, is an important prognostic factor and may be more important than the grade in terms of successful treatment. For example, sometimes a stage I, intermediate or high-grade tumor can be treated with more success than a low-grade tumor that is a stage III.

Low grade	Low, intermediate or high grade	High grade
Acinic cell carcinoma	Adenocarcinoma not otherwise specified (NOS)	Adenoid cystic carcinoma*
Basal cell adenocarcinoma	Mucoepidermoid carcinoma	Anaplastic small cell carcinoma
Clear cell carcinoma	Squamous cell carcinoma	Carcinosarcoma
Cystadenocarcinoma		Small and large cell undifferentiated carcinoma
Epithelia-myoepithelial carcinoma		Salivary duct carcinoma
Mucinous adenocarcinoma		Carcinoma ex pleomorphic adenoma
Polymorphous low-grade adenocarcinoma (PLGA)

• *Some adenoid cystic carcinomas can also be intermediate grade.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

There are no established causes for salivary gland tumors.

There are no established causes for salivary gland tumors.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Salivary gland tumor must be differentiated from other diseases that cause a salivary gland mass or enlargement such as salivary cysts, cysts of the first branchial cleft, salivary gland stones, sarcoid infiltration of the parotid gland, Sjogren’s syndrome, metastasis from other tumors, lymphoepithelial cysts, chronic sclerosing sialadenitis, regional lymphadenopathy, Bell’s palsy, and intraparotid facial nerve schwannoma.^[1][2]

The differential diagnosis of salivary gland tumor includes the following:^[1][2]

• Salivary cysts
• Cysts of the first branchial cleft
• Salivary gland stones
• Sarcoid infiltration of the parotid gland (Heerfordt’s syndrome)
• Sjögren’s syndrome
• Metastases from other tumors such as melanoma of the scalp or face, skin cancer
• Lymphoepithelial cysts
• Chronic sclerosing sialadenitis (Küttner’s tumor)
• Regional lymphadenopathy from infectious, inflammatory, or malignant diseases
• Bell’s palsy
• Intraparotid facial nerve schwannoma

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

The incidence of salivary gland tumors is approximately 2.5 to 3.0 cases per 100,000 individuals worldwide. The incidence of salivary gland tumors is estimated to be 2000 to 2500 cases per year in the United States. The incidence of salivary gland tumors increases with age; the median age at diagnosis is 64 years. Salivary gland tumors are more common in males than females. There is no racial predilection to the salivary gland tumors.^[1]

Malignant salivary gland neoplasms account for more than 0.5% of all malignancies and approximately 3% to 5% of all head and neck tumors.^[1]

The incidence of salivary gland tumors is approximately 2.5 to 3.0 cases per 100,000 individuals worldwide. The incidence of salivary gland tumors is estimated to be 2000 to 2500 cases per year in the United States.^[2][3]

The incidence of salivary gland tumors increases with age; the median age at diagnosis is 64 years. The majority of patients with malignant salivary gland tumors are in the sixth or seventh decade of life.^[1]

Salivary gland tumors are more common in males than females.

There is no racial predilection to the salivary gland tumors.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Common risk factors in the development of salivary gland tumors are age, radiation exposure, environment and occupational exposure, certain viruses, male gender, smoking, and family history.^[1]

Common risk factors in the development of salivary gland tumors includes the following:^[1]

• Age
  • Salivary gland tumors can occur at any age, although it is most commonly diagnosed in older adults. Two out of every 3 salivary gland cancers are found in people 55 and older. The average age at which salivary gland cancers are found is at the age of 64.
• Radiation exposure
  • Radiation therapy to the head or neck for any medical reason may increase the risk of developing salivary gland cancer. There is convincing evidence that exposure to radiation increases your risk for salivary gland cancer. The risk is related to how much radiation someone is exposed to. People who had radiation therapy to the head or neck and atomic bomb survivors have the highest risk. People who had many full-mouth dental x-rays also have a high risk for salivary gland cancer. This is especially true for people who had these x-rays before the 1960s when the doses of radiation were much higher. There is also an increased risk for salivary gland cancer in people who were treated with radioactive iodine-131 for thyroid cancer.
• Environmental or occupational exposure
  • Environment or occupational exposure to sawdust, chemicals used in the leather industry, pesticides, and some industrial solvents may increase the risk of a type of salivary gland cancer that occurs in the nose and sinuses.
• HIV and EBV
  • Viruses that are associated with salivary gland cancer include HIV and the Epstein-Barr virus.
• Male gender
  • Salivary gland tumors are more common in men than in women.
• Family history
  • Rarely, members of some families seem to have a higher than usual risk of developing salivary gland cancers. The majority of people who get salivary gland cancer do not have a family history of this disease.
• Smoking
  • Warthin’s tumor has a strong association with smoking, although in other salivary gland tumors no clear relationship is seen.^[2]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

According to the United States Preventive Services Task Force, screening for salivary gland tumors is not recommended.^[1]

• According to the United States Preventive Services Task Force, screening for salivary gland tumors is not recommended. When salivary gland cancer is found and treated early, the chances of successful treatment are better.
• Regular health checkups are recommended if symptoms of salivary gland cancer develop. As salivary gland cancer is not common, so doctors do not recommend testing for it unless someone has developed symptoms. Still, in many cases salivary gland cancer can be found early, because of its location. Often patients, or their doctors may notice a lump within one of the salivary glands. The routine part of general medical and dental check-ups include checking the salivary glands for tumors.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

If left untreated, patients with salivary gland tumors may progress to develop metastasis. Common complications of salivary gland tumors include metastasis, injury to the facial nerve, and Frey’s syndrome. Prognosis is generally good, and the 5 year mortality rate of patients with salivary gland cancer that has not spread at the time of diagnosis is 91%.^[1][2]

The clinical presentation of a salivary gland neoplasm depends upon its specific site of origin and the extent of involvement of adjacent organs. The most common symptom of major salivary gland cancer is a painless lump in the affected gland, sometimes accompanied by paralysis of the facial nerve. Symptoms due to more advanced minor salivary gland tumors are a function of the location of the tumor and can include nasal obstruction, congestion, vision changes, or trismus when present in the nasal cavity or maxillary sinus. Minor salivary gland tumors involving the nasopharynx usually present at an advanced stage; invasion of the skull base, intracranial extension, or involvement of cranial nerves is common.^[2] If left untreated, patients with salivary gland cancer may progress to develop metastasis. Distant metastases frequently localizes to the lung, followed by liver, and bone.The majority of salivary gland tumors are noncancerous and slow growing.^[1]

Complications of salivary gland tumors include the following:^[2]

• Metastasis
• Rarely, surgery to remove the tumor can injure the nerve that controls movement of the face.
• Frey’s syndrome

Early-stage low-grade malignant salivary gland tumors are usually curable by adequate surgical resection alone. The prognosis is more favorable when the tumor is in a major salivary gland; the parotid gland is most favorable, then the submandibular gland; the least favorable primary sites are the sublingual and minor salivary glands. Large bulky tumors or high-grade tumors carry a poorer prognosis. The prognosis also depends on the following:^[2]

• Gland in which they arise
  • The prognosis is more favourable when the tumor is in a major salivary gland. Parotid gland cancers have the most favorable prognosis, than the submandibular gland and the least favourable primary sites are the sublingual and minor salivary glands. Minor salivary gland tumors tend to be more aggressive in nature than major salivary gland tumors.
• Grade of the tumor
  • Both grade and tumor type are important prognostic factors. Low-grade tumors have a better prognosis than high-grade tumors. Some types of salivary gland cancers have a better prognosis than others.
• Stage of the salivary gland tumor
  • Tumor stage is one of the most important prognostic factors. The survival rate decreases as the stage of the cancer increases.
• Whether the tumor involves the facial nerve, has fixation to the skin or deep structures, or has spread to lymph nodes or distant sites.
  • A salivary gland cancer that causes a loss of facial muscle movement (facial nerve paralysis) is often associated with cancer that has spread to the lymph nodes and distant sites. It usually indicates a poor prognosis.
  • Undifferentiated carcinoma, adenocarcinoma, adenoid cystic carcinoma and squamous cell carcinoma are the types of salivary gland cancers that most often affect the facial nerves. Patients with salivary gland cancer that has spread to the cervical lymph nodes have a poorer prognosis than those who have no metastasis. Some tumors are more likely to spread to the lymph nodes in the neck, while other tumors do not spread as often. Cancers that spread to distant sites within the body generally have a poor prognosis. The chances of having distant metastasis is greater with increased tumor size (T) and lymph node (N) involvement (T and N classifications).
  • Salivary gland tumors with a high malignant potential are more likely to spread to regional lymph nodes and may result in a palpable mass. According to location of the salivary gland the lymphatic drainage varies: the first site of lymphatic spread is the intraparotid lymph nodes, for parotid malignancies followed by level I and level II cervical nodes. Submandibular gland tumors spread to perivascular nodes and then to the cervical region.
  • The sublingual gland drains to the submandibular and submental nodes, and the minor salivary glands within the oropharynx drain to the retropharyngeal nodes. Adenoid cystic carcinoma is associated with a high risk of distant metastases that can occur as late as 10 to 20 years after diagnosis and treatment. Usually, removing the tumor with surgery cures the condition. In rare cases, the tumor is cancerous and further treatment is required.

• Gender
  • Men seem to have poorer outcomes than women. The reasons for this are unknown at this time.
• Histology
  • The prognosis of salivary gland tumors depends on the histological subtype. Histological subtypes of salivary gland tumors can be found here.

The five-year survival rate for people with salivary gland cancer that has not spread at the time of diagnosis is 91%. The five-year survival rate for people with salivary gland cancer that has spread to the surrounding lymph nodes and the five-year survival rate for people with salivary gland cancer that has spread to parts of the body far away from the salivary gland, is 75% and 39% respectively.

Stage	5-year Relative survival rate
Stage I	91%
Stage II	75%
Stage III	65%
Stage IV	39%

Template:WikiDoc Sources