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Acinic Cell Adenocarcinoma of the Parotid Gland

Acinic Cell Adenocarcinoma of the Parotid Gland

Question
Dear OncoLink "Ask the Experts,"
I am a 34 year old female and in October 1993 I had an acinic cell adenocarcinoma removed from my left side parotid gland and it was felt that surgery alone was sufficient and I have had regular checks at the hospital since.

In December 1998 I discovered a small nodule located on the same side but in front of the ear. In January I had a biopsy which indicated suspious cells and was told it was a recurrence of before. I was given the worst scenario which included the facial nerve being severed. A CT scan located the nodule and my consultant was pleased to see that the nodule was quite superficial and was quite confident she could remove it with no major complications.

On March 17th I underwent surgery. On recovery I was told that there was good news and that the lump could not be located as there was severe scar tissue but samples of the surrounding tissue returned negative. I couldn't quite see the good news as the suspicious nodule hadn't been removed, although the surrounding tissue was negative the offending nodule was still there!

Would you recommend radiotherapy as a precaution or do you think just monitoring the situation is sufficient. I fully understand your position is educational purposes only but would much appreciate your advice.  
Thank you.
S.M


Answer
Li Liu, MD, OncoLink Editorial Assistant, responds:

Dear S:
Thank you for your interest and question.

For parotid cancers, the generally accepted indications for postoperative radiation therapy are microscopically or grossly positive margins after radical surgery, recurrent cancers, high-grade histology, and advanced-stage cancers. Acinic cell adenocarcinoma of the parotid gland comprises a group of low to moderate grade malignancies.

You mentioned that no cancer could be identified at the time of surgery. There are at least two possibilities: the recurrent cancer could have been removed at the time of biopsy if the biopsy was excisional or simply the surgeon missed the recurrent disease.

As far as what to do now, you may want to have the slides from the January biopsy re-reviewed to confirm the presence of cancerous cells. You may also benefit from a repeat CT scan, to see if there is any sign of disease present. If either the slides or the scans show concern, you might consider seeking the opinion of a radiation oncologist and have them confer with your surgeon.

Please discuss these options with your current care team.