Treatment for adenoid cystic carcinoma

Surgery is usually the most effective treatment for ACC if the cancer can be safely removed. Surgery usually involves removing the cancer and some healthy tissue around the cancer. This is called a wide local excision. The healthy tissue is removed to help reduce the risk of the cancer coming back in that area.

The extent of the operation depends on where the cancer is and how far it has spread. The surgeon will examine nearby nerves and lymph nodes and may remove them if they are involved. It can be a difficult decision to remove nerves, especially major nerves or those that control the face. It is important that your surgery is carried out by a surgeon with special expertise in this area.

Download our booklet ‘Understanding Surgery’

Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells. It may be used effectively for ACC after surgery, to destroy any remaining cancer cells and stop the cancer coming back. It might also be used alone if surgery is not possible, for example:

• if the cancer is in a place in the body that is too hard to reach using surgery
• if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain).

A course of radiation therapy needs to be carefully planned. During your first consultation session you will meet with a radiation oncologist. At this session you will lie on an examination table and have a CT scan in the same position you will be placed in for treatment. The information from this session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.

Radiation therapy does not hurt and is usually given in small doses over a period of time to minimise side effects.

Download our booklet ‘Understanding Radiation Therapy’

Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways.

Chemotherapy is not commonly used for ACC. It may be considered when the cancer is advanced as part of palliative treatment or as part of a clinical trial. Your medical oncologist will discuss options with you.

Chemotherapy is given through a drip into a vein (intravenously) or as a tablet that is swallowed. It is given in treatment cycles which may be daily, weekly or monthly. For example, one cycle may last three weeks where you have the drug over a few hours, followed by a rest period before starting another cycle. The length of the cycle and number of cycles depends on the chemotherapy drugs being given.

Download our booklet ‘Understanding Chemotherapy’

Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.

You may find it helpful to talk to your specialist, GP, or clinical trials nurse. If you decide to take part in a clinical trial, you can withdraw at any time.

Visit Australian Cancer Trials for information or contact the Australian and New Zealand Head and Neck Cancer Society who have a special fund to support research into ACC.

Download our booklet ‘Understanding Clinical Trials and Research’

Complementary therapies tend to focus on the whole person, not just the cancer, and are designed to be used alongside conventional medical treatments (such as surgery, chemotherapy and radiation therapy). They can increase your sense of control, decrease stress and anxiety, and improve your mood.

Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to create patient-centred cancer care that aims to improve both wellbeing and clinical outcomes.

Some complementary therapies and their clinically proven benefits are listed below:

acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life.

aromatherapy – improves sleep and quality of life

art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings

counselling, support groups – help reduce distress, anxiety and depression; improve quality of life

hypnotherapy – reduces pain, anxiety, nausea and vomiting

massage – improves quality of life; reduces anxiety, depression, pain and nausea

meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life

qi gong – reduces anxiety and fatigue; improves quality of life

spiritual practices – help reduce stress; instil peace; improve ability to manage challenges

tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life

yoga – reduces anxiety and stress; improves general wellbeing and quality of life.

Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Download our booklet ‘Understanding Complementary Therapies’

If you have been diagnosed with ACC, both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.

Eating well and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood. You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.

Download our booklet ‘Nutrition for People Living with Cancer’

Download our booklet ‘Exercise for People Living with Cancer’

All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects while others can have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.

After surgery or radiation therapy to the head and neck area, you may need to adjust to significant changes. Everyone will respond differently – talk to your doctor about what to expect and try to see a speech pathologist and/or dietitian before treatment starts. Some long-term side effects of treatment to this area include:

• mouth problems, including dry mouth
• heartburn or indigestion
• taste and smell changes
• swallowing difficulties
• speech or voice changes
• breathing changes
• appearance changes.

Common side effects may include:

Surgery – Bleeding, damage to nearby tissue and organs (including nerves), drug reactions, pain, infection after surgery, blood clots, weak muscles (atrophy), lymphoedema.

Radiation therapy – Fatigue, loss of appetite, nausea, hair loss, dry mouth, skin problems, lymphoedema.

Chemotherapy – Fatigue, loss of appetite, nausea, bowel issues such as constipation or diarrhoea, mouth sores, skin and nail problems, increased chance of infections, loss of fertility, early menopause.