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
Frequently Asked Questions
Adenoid Cystic Carcinoma is an unusual but not rare cancer that primarily affects the oral cavity and head and neck regions. It generally grows slowly and tends to spread along nerves, making complete removal challenging. However, it usually does not spread to distant parts of the body like many other cancers.
No, Adenoid Cystic Carcinoma is not related to smoking or drinking. The exact cause of this cancer remains unknown despite ongoing research.
Surgery remains the mainstay of treatment for Adenoid Cystic Carcinoma, particularly tumors located at the base of the tongue. Advances in surgical techniques focus on removing the tumor while sparing important structures to preserve function or reconstruct them if necessary.
Robotic surgery is a recent advancement that allows surgeons to remove tumors, such as those at the base of the tongue, with minimal damage to surrounding tissues. This technique involves less extensive exposure, reducing disability and preserving the pharynx, larynx, tongue, and nerves.
Robotic surgery is still a relatively new technique and is not widely available at many medical centers. It is important to seek out head and neck surgeons with specific experience in robotic-assisted procedures for the best outcomes.
For cases involving robotic surgery, experienced surgeons like Dr. Gregory Weinstein at the University of Pennsylvania are highly recommended. Your brother should consult head and neck surgeons in his area with strong experience and consider getting second opinions from renowned centers such as UCSF or other top hospitals.
Adenoid Cystic Carcinoma typically grows slowly and tends to stay localized due to its nerve-based spread pattern. While complete surgical removal can be challenging, recent advances in surgical techniques have improved the ability to treat the tumor effectively with preservation of function.
