Mucoepidermoid carcinoma
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.
Overview
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.
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.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Check before combiningFood and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
- Check before combiningKidneys: Carboplatin
Dose by Calvert formula using GFR (see the calculators).
- Check before combiningKidneys: Cisplatin
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Good to knowImmune-related endocrinopathies (thyroiditis, hypophysitis)
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:CarboplatinCisplatinPaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
Anatomy and lymph node drainage
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- Thyroid
- Nodes: level I (submandibular)
- Nodes: level II (upper jugular)
- Nodes: level III-IV (jugular)
- Nodes: level V (posterior)
- Nodes: level VI (central, thyroid)
- Nodes: retropharyngeal (nasopharynx)
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glandsLow-grade mucoepidermoid carcinoma (mostly cured by surgery) · Intermediate-grade mucoepidermoid carcinoma · High-grade mucoepidermoid carcinoma · Mucoepidermoid carcinoma of the palate and other minor salivary glands · Paediatric mucoepidermoid carcinoma, including after radiotherapy or chemotherapy
- Thyroid
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer
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.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
Resection with neck dissection and postoperative radiotherapy; cisplatin chemoradiation considered for extranodal extension or positive margins.
Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive or mutation-rich tumours; observation for indolent low-grade metastases.
Pan-salivary and pan-tumour trials of new agents that accept mucoepidermoid carcinoma.
Subtypes & biomarkers
top- 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
- 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
How often this target appears
- 1945Stewart, Foote and Becker name mucoepidermoid tumours of the salivary glands
- 2003CRTC1-MAML2 fusion identified as the defining genetic event
- 2017WHO classification confirms MAML2 fusion as diagnostic and prognostic
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 4 changes by month →- 2026-09-17This recordMucoepidermoid carcinomaFacts on this page last checked
When this page itself was last checked or edited.
- 2017MilestoneMucoepidermoid carcinomaWHO classification confirms MAML2 fusion as diagnostic and prognostic
A milestone in how this cancer is treated.
- 2003MilestoneMucoepidermoid carcinomaCRTC1-MAML2 fusion identified as the defining genetic event
A milestone in how this cancer is treated.
- 1945MilestoneMucoepidermoid carcinomaStewart, Foote and Becker name mucoepidermoid tumours of the salivary glands
A milestone in how this cancer is treated.
What is in development for Mucoepidermoid carcinoma, drawn from the whole corpus: 2 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 3 · 1
Trials under way · 1
- A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors · phase 1/2 · Day One Biopharmaceuticals, Inc.
Open problems and what is being done
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.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - | |
Freiburg im Breisgau · cancer center | Germany | none recorded | 0 | 549 | 5,261 | - | |
Lausanne · hospital | Switzerland | none recorded | 0 | 509 | 9,176 | - | |
Brussels · cancer center | Belgium | none recorded | 0 | 489 | 8,689 | - | |
Geneva · hospital | Switzerland | none recorded | 0 | 441 | 6,485 | - | |
Madison, WI · cancer center | United States | 0 | 424 | 10,177 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Mucoepidermoid carcinoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Mucoepidermoid carcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example MAML2 rearrangement by FISH, Histological grade, Margin status and perineural invasion, Nodal spread and extranodal extension, Ki-67), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Low-grade mucoepidermoid carcinoma, Intermediate-grade mucoepidermoid carcinoma, High-grade mucoepidermoid carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Low-grade, localised
- For my situation (low-grade, localised), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Intermediate- and high-grade or node-positive
- For my situation (intermediate- and high-grade or node-positive), which of the standard options do you recommend and why?Why: Guideline options include: Resection with neck dissection and postoperative radiotherapy; cisplatin chemoradiation considered for extranodal extension or positive margins.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive or mutation-rich tumours; observation for indolent low-grade metastases.
- Am I a candidate for Cisplatin, Carboplatin, Paclitaxel / nab-paclitaxel or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Trials
- For my situation (trials), which of the standard options do you recommend and why?Why: Guideline options include: Pan-salivary and pan-tumour trials of new agents that accept mucoepidermoid carcinoma.
- Am I a candidate for Gotistobart, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Gotistobart, A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors, Pembrolizumab?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “No targeted drug for the MAML2 fusion”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Grading systems disagree, so treatment intensity varies between centres”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Mucoepidermoid carcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
4targets
2drugs
5companies
3terms
3trials
1Latest papers
topQuery for this cancer: (TITLE:"Mucoepidermoid carcinoma" OR ABSTRACT:"Mucoepidermoid carcinoma" OR TITLE:"MEC" OR ABSTRACT:"MEC" OR TITLE:"Mucoepidermoid carcinoma of the salivary glands" OR ABSTRACT:"Mucoepidermoid carcinoma of the salivary glands") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Mucoepidermoid carcinoma, not a curated reading list.
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