One of the most effective treatments for Adenoid Cystic Carcinoma (ACC) is surgery. Before the operation, the patient will meet with their surgical team of different doctors and specialists. This will give the team another chance to brief the patient about the surgery they are about to undergo, review medical history, and perform any physical exams needed. The patient will then have to sign off on an informed consent form. Signing means that they chose to get the surgery, the surgical team provided the necessary information and other options, and understand that the surgery is not guaranteed to produce the intended results. Additional testing may also be required such as a blood test and ultrasound or a type of Imaging scan.
During the actual procedure, an anesthesiologist will administer the anesthesia and monitor the blood pressure, oxygen levels, and heart rate. Once the patient is successfully under anesthesia, the tumors are then surgically removed. Because ACC usually spreads along nerves, the surgeon must take care to avoid as many major nerves as possible while still taking out 2 mm of surrounding healthy tissue. This will make the margin clean. A clean, or negative, the margin is used to describe the edge of the tissue with no cancer cells. This will determine whether the cancer is still present in that particular spot, keeping in mind that ACC tends to metastasize even with clean margins.
While surgery is one of the best treatments, there are side effects that need to be considered. Side effects depend on the location of the tumor that was surgically removed. For example, if a tumor is located in the parotid gland. A surgical procedure can result in nerve damage. This can result in the surrounding muscles “drooping”. In that case, reconstructive surgery may be an option.
ACC can also be treated by radiotherapy. Radiotherapy is the treatment of disease using ionizing radiation. In other words, high-energy X-ray treatment. The goal is to get the optimum amount of energy to the tumor and the minimum amount to the healthy tissue. Radiotherapy is particularly effective as an adjuvant treatment. Adjuvant treatment is in addition to surgery to kill any remaining cells and prevent local recurrence. One benefit to radiotherapy is that it is given as an outpatient treatment, meaning the patients are not required to stay in a hospital throughout the course of the multiple treatments. The radiation can not be seen or felt at the moment. Side effects, like all treatments, are an issue for radiotherapy. For head and neck tumors (where most ACC starts), fatigue is a very common symptom along with redness and inflammation of the skin and the inside of the mouth or throat. Loss of taste is a result of inflammation. A long-term side effect is a dryness in the mouth caused by damaged salivary glands.
A more specific type of radiotherapy that is becoming more available (the type of radiation my mom received) is proton beam therapy. In 1946, Robert R Wilson wrote about radiation treatment with accelerated protons. He was developing cyclotron acceleration at Harvard. For the next forty years, the technology was developed, and the first commercial use facility was built in 1989 at Clatterbridge Center. This type of radiation therapy is Proton Beam Therapy. The accelerated protons have an electrical charge and only really damage the tumor rather than the surrounding tissue.
Common side effects for patients that had tumors in the head or neck (like most with ACC) that received Proton Beam Therapy are different skin reactions. The skin of the treated area can become dry or irritated. Mucosal reactions are also common, such as dryness. drainage, and pain in the area. Because of the soreness and pain in the mouth and throat, weight loss is also common for patients.
Before treatment, the patient will have a CT or MRI scan to locate the tumors that will be treated that day. While having the scan, the patient is expected to be in the same position as they would be for the actual treatment. Because the movement should be kept at a minimum, they are often fitted with a custom device that keeps you in the necessary position. The therapy is administered in a special treatment room where the patient lies down on a table, or in some cases, a chair. Some facilities have a gantry that moves around the patient to get the best possible angles for every treatment. The entire process, starting from walking into the room and ending when walking out, takes somewhere between 15-30 minutes a session.
One of the biggest “pro” to proton beam therapy is that the surrounding, healthy tissue is exposed to up to 60% less radiation than before. This allows for a higher dose of radiation to be administered to the tumor. One of the biggest “con” is the price. Because the equipment necessary is so expensive, only a few facilities in the U.S. has the equipment for this type of radiation.