# Mucoepidermoid carcinoma

Source: https://onco.cc/cancers/mucoepidermoid-carcinoma/  
OnCo record `mucoepidermoid-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Mucoepidermoid carcinoma is the most common salivary gland cancer and, for most people, one of the most curable: low-grade tumours are removed surgically and rarely return, while high-grade tumours need radiotherapy after surgery and are treated like other aggressive head and neck cancers if they spread.

## Summary

Mucoepidermoid carcinoma is made of mucous, intermediate and squamous-like (epidermoid) cells in varying proportions, and most tumours carry a CRTC1-MAML2 or CRTC3-MAML2 fusion that drives CREB-regulated genes and marks a better outlook. It arises in the parotid, the minor salivary glands of the palate and lips, and the bronchi, and it is the commonest salivary cancer in children and after radiotherapy or chemotherapy for a childhood cancer. Grade, assigned by histological systems such as the AFIP and Brandwein scores, is the strongest predictor of behaviour: low-grade tumours are indolent, high-grade tumours spread to nodes and distant sites.

Treatment is surgical. Low-grade tumours are cured by complete excision with a margin (superficial or total parotidectomy preserving the facial nerve, or excision of the palatal lesion), and do not need radiotherapy when margins are clear. High-grade and intermediate-grade tumours, and any with positive margins, perineural invasion or nodal spread, are treated with neck dissection and postoperative radiotherapy, with cisplatin chemoradiation considered for extranodal extension or positive margins by analogy with squamous cell carcinoma.

There is no targeted therapy: the MAML2 fusion is not directly druggable, though it drives amphiregulin and EGFR signalling that has been explored preclinically. Recurrent or metastatic high-grade disease is treated with platinum-based chemotherapy, with pembrolizumab for the uncommon PD-L1-positive or mutation-rich tumour, and patients are offered the pan-salivary trials of new agents. Indolent low-grade metastases, which are rare, may be observed.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: MEC; Mucoepidermoid carcinoma of the salivary glands
- Tags: subtype-page; head-and-neck
- Group: head and neck
- Burden: The commonest salivary gland cancer in both adults and children, most often in the parotid or the minor glands of the palate; low-grade tumours are cured by surgery in nearly every case, while high-grade tumours behave like other aggressive head and neck cancers.
- Subtypes: Low-grade mucoepidermoid carcinoma (mostly cured by surgery); Intermediate-grade mucoepidermoid carcinoma; High-grade mucoepidermoid carcinoma; CRTC1-MAML2 or CRTC3-MAML2 fusion-positive disease (the majority, better outlook); Mucoepidermoid carcinoma of the palate and other minor salivary glands; Paediatric mucoepidermoid carcinoma, including after radiotherapy or chemotherapy
- Biomarkers: MAML2 rearrangement by FISH (confirms the diagnosis); Histological grade (AFIP or Brandwein system); Margin status and perineural invasion; Nodal spread and extranodal extension; Ki-67

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/mucoepidermoid-carcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/mucoepidermoid-carcinoma/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/mucoepidermoid-carcinoma/#what-it-is [6 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/mucoepidermoid-carcinoma/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/mucoepidermoid-carcinoma/#treating-it [4 settings, 2 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/mucoepidermoid-carcinoma/#evidence [1 trial, 3 key papers, 3 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/mucoepidermoid-carcinoma/#science [4 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/mucoepidermoid-carcinoma/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/mucoepidermoid-carcinoma/#living-with-it [17 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/mucoepidermoid-carcinoma/coming/ [5 medicines, 1 trial, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/mucoepidermoid-carcinoma/data/ [24 connected records]

## Standard of care

- Low-grade, localised: Complete excision with a margin (parotidectomy preserving the facial nerve, or excision of the minor gland lesion); postoperative radiotherapy only for positive margins that cannot be re-excised. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Intermediate- and high-grade or node-positive: Resection with neck dissection and postoperative radiotherapy; cisplatin chemoradiation considered for extranodal extension or positive margins. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/))
- Recurrent or metastatic: Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive or mutation-rich tumours; observation for indolent low-grade metastases. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [PD-L1 expression testing (22C3, SP142, SP263)](https://onco.cc/terms/pd-l1-testing/))
- Trials: Pan-salivary and pan-tumour trials of new agents that accept mucoepidermoid carcinoma. ([Gotistobart](https://onco.cc/drugs/gotistobart/), [A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors](https://onco.cc/trials/nct05377996/))

## State of the art

- Grade and margins, not molecular markers, still decide treatment.
- The MAML2 fusion confirms the diagnosis and predicts a better course but has no drug.
- Facial-nerve-sparing parotidectomy cures most patients with low-grade disease with little morbidity.

## Open problems

- No targeted drug for the MAML2 fusion.
- Grading systems disagree, so treatment intensity varies between centres.
- High-grade disease has outcomes as poor as squamous cell carcinoma.
- Second cancers in children treated for the disease.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Mucoepidermoid_carcinoma
- Wikipedia: https://en.wikipedia.org/wiki/Mucoepidermoid_carcinoma

## Connected records

- cancers: [Adenoid cystic carcinoma](https://onco.cc/cancers/adenoid-cystic-carcinoma/), [Salivary duct carcinoma](https://onco.cc/cancers/salivary-duct-carcinoma/), [Salivary gland cancers](https://onco.cc/cancers/salivary-gland/)
- key papers: [EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer](https://onco.cc/key-papers/paper-bernier-eortc-22931-nejm-2004/), [Systemic therapy in the palliative management of advanced salivary gland cancers (review)](https://onco.cc/key-papers/paper-laurie-licitra-salivary-systemic-jco-2006/), [The t(11;19) translocation in mucoepidermoid carcinoma creates a CRTC1-MAML2 fusion](https://onco.cc/key-papers/paper-tonon-crtc1-maml2-nat-genet-2003/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Gotistobart](https://onco.cc/drugs/gotistobart/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- trials: [A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors](https://onco.cc/trials/nct05377996/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Extranodal extension (ENE)](https://onco.cc/terms/extranodal-extension/), [PD-L1 expression testing (22C3, SP142, SP263)](https://onco.cc/terms/pd-l1-testing/)
- targets: [CRTC1](https://onco.cc/targets/crtc1/), [MAML2](https://onco.cc/targets/maml2/)

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JSON: https://onco.cc/api/v1/entities/mucoepidermoid-carcinoma.json