Treatment Options for Adenoid Cystic Carcinoma
Dear OncoLink "Ask the Experts,"
My mother had noticed a lump in her right cheek for sometime. After a biopsy, she has just been diagnosed with cancer of the parotid gland. They are calling it an adenoid cystic epithelial carcinoma. On CT of the chest, there were two nodules in the right upper lobe of the lung. Please advise as to what is the best option.
John Han-Chih Chang, MD, OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
The type of cancer that you are talking about is a major salivary gland cancer. There are 3 types of major salivary glands in the head and neck. The parotid is the largest one, located in both cheeks. It provides the majority of the watery saliva in your mouth. Most tumors in the parotid are benign, but cancers are not uncommon. Cancers of the parotid are most commonly mucoepidermoid or adenoid cystic carcinomas.
Treatment of such disease in your mother's case is difficult to determine. It appears that CT scan has lesions that are suspicious for metastases or spread of her cancer to the lungs. This is very common for adenoid cystic carcinomas to spread to the lungs very early on in its diagnosis. Please ask your oncologist, otorhinolaryngologist (ENT) or other cancer doctor to determine if the CT findings are suspicious for malignancy. Despite spread of this disease distantly to the lungs, there have been cases where patients with this condition have survived many years. Thus, local treatment to the primary tumor itself and regional lymph nodes is important it controlling this disease.
Local treatment comes in the form of surgery if possible followed by radiation therapy. Chemotherapy in this disease remains investigational at this point, but may be indicated since there is systemic evidence of the cancer. Cisplatinum and Taxol are two of the drugs under study. The radiation therapy is usually given post-operatively and is effective as an adjunct to surgery, which is the mainstay of local treatment. If radiation is utilized alone, twice a day photon therapy or neutron therapy is advisable for the optimal local control.
Again, please consult your mother's cancer physicians concerning the best mode of treatment for her cancer.