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Risk Factors for Local Recurrence of Adenoid Cystic Carcinoma

Adenoid cystic carcinoma (ACC) is a relatively rare type of cancer but is malignant. Finding an optimal treatment for it is quite difficult even after carrying out a lot of clinical trials based on a lot of patients. This type of cancer usually affects surrounding areas such as the salivary glands and head and neck. However, it can also occur in other parts of the body, such as breast tissue, skin, prostate, and cervix. 

If you consider overall cases of ACC then only 1 percent of them affect the head and neck. The tumour may be solid, hollow, round, or perforated. Women are more susceptible to this cancer than men and often appear in groups between the ages of 40 and 60. 

Staging in ACC

Doctors do staging in ACC using the TNM staging system which, in other words is the AJCC system. TNM is an acronym for Tumour Node Metastasis. Here ‘T’ means where the tumour is located and how big it is. N or node brings up the question if cancer has spread to the lymph nodes or not. Finally, ‘M’ means metastasis ie, if cancer has spread to other body parts or not. Diagnosis of the patients is often in use to answer these questions and also to come up with the stage of ACC. There are five stages ranging from stage 0 which goes up to stage 4. 

So, a stage I mean the tumor is non-invasive is usually T1 or T2 while lymph nodes are not affected(N0), and there is no metastasis(M0). Stage II means an invasive tumor but lymph nodes are still not in effect. In fact, Stage III tells that the tumor has spread to the lymph nodes but has no metastasis. Stage IV happens when a tumor is invasive that may or may not have metastasis and probably affects the lymph nodes. Stage IV has subcategories i.e., IVA, IVB, and IVC.

What are the signs and symptoms? 

This cancer affects many parts of the body, so symptoms depend on which part of the body is affected. Salivary gland ACC can cause facial pain, sagging, and numbness in the lips and surroundings. When ACC affects the lacrimal duct, it can cause blurred vision, swelling of the eyes, pain, and swelling near the lacrimal duct. ACC, which affects the skin, can cause pain, bleeding, pus accumulation, hair loss, and increased sensation of pain in the affected area. The joints near the areola usually develop when they affect the breast. In the case of the cervix, there may be vaginal discharge and bleeding as well as pain. ACC in the prostate can lead to frequent urination and reduced urinary flow. 

What is the cause? 

It turns out that there exists involvement of certain genes in this type of cancer. In addition, certain lifestyle choices can contribute to an increased risk of illness. One such factor is that smoking and drinking can have a significant impact on a patient’s response to the prescribed treatment. BMI or body mass index is a potential contributor to this cancer. Studies show that diet and nutrition can adversely affect treatment, promote healing, or play no role at all. Therefore, diet and nutrition supplements are essential for faster recovery and potentially improved quality of life.

Risk factors involved

ACC of the head and neck have a high likelihood of metastasis or spreading of the tumor, especially to the lungs, although metastasis to the lymph nodes is not common. It is infamous for its local recurrence, infiltrative local growth, and perineural invasion propensity. Since it is quite rare, there is very little research and trials carried out for this cancer. Risk factors for ACC include positive resection margins, perineural invasion, vascular invasion, and solid-type pathology.

Treatments available

Several treatments are available for ACC out of which radiation therapy and surgery are most commonly used. Management in such a situation depends on many factors, some of which include cell type and degree of differentiation and the condition of the lymph nodes, and the presence of bones. Therapeutic management should also consider preserving speech and swallowing function and also deal with the complications that may arise in the course of treatment. The treatment of ACC is becoming frenzied due to its unreliable occurrence and nature, repeated and late recurrence, and sometimes longevity compounded by recurrent and metastatic nature. However, a review of the studies shows that the best survival outcomes are when surgery and radiation are combined.

If an analysis is made retrospectively, then radiation therapy carried out after performing surgery seems to be a standard treatment. While data from definitive radiotherapy seems to be effective for ACC of the head and neck. Results of another study show that advanced T-stage and positive microscopic margins are important factors in determining the need for postoperative radiation therapy in head and neck ACC and surgical margins for early T-stage and negative tumors. It suggests that radiation therapy should be avoided in patients with it. It may not be necessary.

Summing up 

ACC is a rare but malignant cancer, with head and neck cancer accounting for only 1 percent of ACC cases. Even though the standard treatment is surgery followed by radiation therapy. But the studies show that it might not be the solution we are seeking. Definitive radiation therapy could provide a better approach to treating the ACC of the head and neck. Nevertheless, much research must be done to enhance the diagnosis and treatment of head and neck ACC. This helps improve the patient’s quality of life and survival.

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