Question: I am so devastated by the news that my 55-year-old older healthy brother has been diagnosed with Adenoid Cystic Carcinoma while going in for a checkup of his sinus and sleep apnea problem. He lives in San Mateo California and has had his biopsy which shows a small mass at the base of his tongue on the left side. He is going to get a second opinion at UCSF. At the same time, I am trying different reputable and top hospitals to find a very good oncology surgeon in the Bay Area. Can you please tell me who he should see and have the surgery by without extensive damage to the pharynx, larynx, tongue, and nerves. I am desperate for names even at locations outside the Bay Area.
Answer:
Thank you for your note. I share your concern about your brother. Adenoid cystic carcinoma is an unusual but not rare cancer of the oral cavity and head and neck. It is not related to smoking or drinking, and today we still do not know the cause. It tends to grow slowly but spreads along nerves in the tissues, so that it may be difficult to remove in its entirety. However, it tends not to spread to distant areas as do many cancers. Surgery remains the mainstay of its treatment. We have made many advances in recent years in caring for tumors of the head and neck. Most important has been the ability to spare important structures and their functions, or to reconstruct them- if needed.
Today, ROBOTIC SURGERY is one of the latest advances in head and neck surgery. It is especially helpful in tumors of the oral cavity- such as the base of tongue- Using robotic assistance can allow the surgeon to remove tumors of the base of tongue- perhaps such as your brother’s- without needing the wide exposure that can cause significant damage to the patient’s normal tissues and the disability that would cause. Dr. Krevitt and I have had training in robotic surgery. However, this is a relatively new technique, and not readily available in many places. I would suggest your brother see the head and neck surgeon in his area has the most experience in this. A good resource, or person to see, would be Gregory Weinstein at the University of Pennsylvania, who probably has the most experience in this.
I hope this helps and that all goes well for your brother.
Robert L Pincus MD
