The current standard of care for newly diagnosed ACC patients involves surgical resection with follow up radiation. “Standard of care” means the best treatments known.
Patients often work with a doctor, likely an Otolaryngologist who is surgically trained to work with cancers of the ear, nose and throat (ENT). This specialty can be further broken down to those that specialize in the sinuses, orbit, ears, neurology, reconstruction, plastics and more. It is not uncommon to have a team of surgeons involved with the initial surgery to remove the primary tumor.
The primary goal during surgery is to remove all of the visible tumor with a clear margin of healthy tissue surrounding the tumor; also called ‘negative margins’. In a fairly large number of cases these two standard treatments do stop the cancer and an ACC patient may never experience a local recurrence of the ‘primary site’.
Although removing all the cancer is normally the treatment goal, preserving the function of the nearby nerves, tissue and bone is also very important. When discussing your treatment goals with your doctor(s), learn about how surgery may impact your life as well as how to manage the short and long-term side-effects. Much of this is based on the anatomy or location of your tumor.
In some cases, the tumor may be inoperable due to its location or surrounding impact. Seeking a second opinion can provide another perspective or offer other options such as different surgical techniques to effectively remove part or all of the tumor. This could include options to shrink the tumor by means of systemic therapy to make surgery possible.
Following surgery, there may be additional options such as reconstructive surgery or radiation therapy:
- Reconstructive procedures such as facial reanimation surgery or nerve grafting may be suggested to reduce or eliminate paralysis due to never damage. Reconstruction surgery might also be recommended when surgery involves the removal of bone and other critical structures. In this case healthy bone/nerves/skin may be taken from other areas of the body. In other cases, a prosthetic device might be suggested.
- Radiation therapy is normally recommended due the difficulty in achieving clean surgical margins or the high risk of perineural spread (nerve invasion to surrounding tissues). Radiation therapy is an effective way of destroying microscopic cancerous cells around the original tumor bed including lymph nodes and major nerves in the head and neck.