ACINIC CELL CARCINOMA STATISTICS

 

STATISTICS

SOURCE

PUBLICATION DATE

TIME PERIOD STUDIED

# OF PATIENTS IN STUDY

All new carcinomas of the major salivary glands reported to the National Swedish Cancer Registry 1960-1995 were reviewed.  The study comprised 2465 patients with carcinoma of the parotid or submandibular glands. Relative survival differed markedly according to histopathological typing (P<0.001). For parotid tumors, acinic cell carcinomas had the best prognosis with a 10-year relative survival of 88%.

Oral Oncol 2002 Oct;38(7):706        

Carcinoma of the parotid and submandibular glands-a study of survival in 2465 patients.

Wahlberg P, Anderson H, Biorklund A, Moller T, Perfekt R.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, S-221 85, Lund, Sweden

 

Oct. 2002

1960-1995

2465 various carcinomas of major salivary glands

Acinic Cell Adenocarcinoma accounts for about 6% of all salivary gland tumors.

UCLA School of Medicine website:

http://wwwpathnet.medsch.

ucla.edu/med-edu/

pathrev/saliv/mt/acinic.htm

As of 6/2002

 

 

The vast majority (83%) occur within the parotid gland, usually as a slowly enlarging mass.

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

EPIDEMIOLOGY:

Incidence: 3rd most common epithelial malignancy of the salivary gland.

17% of all primary salivary gland malignancies

6% of salivary gland neoplasms

Age Range - Median: Mean age is 44 years

12% of patients < 20 years

Sex (M:F):  2:3

Geography: No racial predilection

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

Synchronous or metachronous:

3% of cases are bilateral

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

PROGNOSIS:   Poor factors include:

  • Short duration of symptoms
  • Incomplete excision
  • Frequent mitoses
  • Focal necrosis
  • Neural invasion
  • Pleomorphism
  • Infiltration
  • Stromal hyalinization
  • Large size
  • Involvement of the deep lobe of the parotid gland

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

SURVIVAL:  About 16% die from the tumor.

RECURRENCE: 35%, usually within first 5 years after resection of the primary tumor.

METASTASIS:  16%

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

TREATMENT:  Complete surgical excision.

 

Radiation may improve survival in patients for whom complete surgical excision cannot be achieved.

The Doctorıs Doctor.com page on Acinic Cell Carcinoma:  http://www.thedoctorsdoctor.com/

diseases/aciniccell_ca.htm

As of 6/2002

 

 

Overall, salivary cancers make up approximately 3% of all head and neck malignancies that are diagnosed in North America each year; most of these are in the parotid glands. Sublingual and minor salivary gland cancers are unusual.

 

Overall, the majority of salivary gland neoplasms are benign, a fact that reflects an overwhelming predominance of parotid tumors, three-fourths of which are nonmalignant.

 

Acinic cell carcinoma is an uncommon malignancy that probably accounts for fewer than 10% of all salivary gland cancers. Although acinic cell lesions usually are seen in the parotid gland, they occasionally occur in the submandibular gland.  They are low grade, only infrequently invade the facial nerve, and are late to metastasize. When they do metastasize, however, it is usually to the lungs, and under these circumstances, death usually follows. Because of their slow growth, survival data are good when generous surgical excision is performed.

Cancer: Principles & Practice of Oncology, 6th Edition

Author(s): Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven A. Rosenberg, MD, PhD    

Date: January 2001

Chapter 30.4: Tumors of the Salivary Glands and Paragangliomas

Roy B. Sessions

Louis B. Harrison

Arlene A. Forastiere

Major Salivary Gland Tumors:

Acinic Cell Carcinoma

 

References:

Spiro R. Salivary neoplasms: overview of 25 years' experience with 2,807 patients. Head Neck Surg 1986;8:177. 

 

 

Perzin K, Livoisi V. Acinic cell carcinoma arising in ectopic salivary gland tissue. Cancer 1980;45:967.

January 2001

 

 

Symptoms: Most patients with benign tumors, whether in minor or major salivary glands, present with asymptomatic swelling of the lip or the parotid, submandibular, or sublingual glands (floor of the mouth). Neurologic signs, such as mucosal or tongue numbness, associated with a floor of mouth mass usually indicate a malignancy. In the presence of a lip mass, a numb lower lip can result from tumor involvement of the submental nerve. Facial nerve weakness that is associated with a parotid or submandibular tumor is an ominous finding. Even in huge tumors of the parotid gland that are benign, the facial nerve usually is not affected. Essentially, any compromise in nerve function greatly heightens concern for malignancy. Overall, malignant parotid gland tumors are associated with facial nerve paralysis in 10% to 20% of patients.  Although benign tumors occasionally cause facial discomfort, persistent facial pain is strongly suggestive of malignancy in a salivary gland tumor; in fact, approximately 10% to 15% of patients with malignant parotid neoplasms present with pain.  Furthermore, those malignancies that are characterized by pain seem to have a worse prognosis.

 

The majority of parotid tumors, whether benign or malignant, present with an asymptomatic mass in the gland; in fact, this is the case even in the majority of malignant tumors.

 

Cancer: Principles & Practice of Oncology, 6th Edition

Author(s): Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven A. Rosenberg, MD, PhD    

Date: January 2001

Chapter 30.4: Tumors of the Salivary Glands and Paragangliomas

Roy B. Sessions

Louis B. Harrison

Arlene A. Forastiere

Major Salivary Gland Tumors:

 

References:

Spiro R, Huvos A, Strong E. Cancer of the parotid gland. Am J Surg 1975;130:452

 

Frankenthaler R, Luna M, Lee S, et al. Prognostic variables in parotid gland cancer. Arch Otolaryngol Head Neck Surg 1991;117:1251.  

January 2001

 

 

STATISTICS

SOURCE

PUBLICATION DATE

TIME PERIOD STUDIED

# OF PATIENTS IN STUDY

Salivary gland cancers are very uncommon and account for less than 1% of all cancers, and about 7% of cancers of the head and neck area. The survival rates for malignant salivary gland tumors depend on the cell type and the stage of the cancer. The stage of the cancer depends on its size and whether or not it has spread to other parts of the body.

What Are the Key Statistics for Salivary Gland Cancer?

Cancer Reference Information

American Cancer Society website

http://www.cancer.org/eprise/

main/docroot/CRI/

content/CRI_2_4_1X_What_are

_the_key_statistics_for_

salivary_gland_cancer_54?

sitearea=CRI

 

 

As of 2001

 

 

Distant Metastasis Rates in Parotid Carcinomas by Histology:

Acinic Cell Carcinoma: 2/14 (14%)

Cancer Medicine, 5th Edition 

Bast, Robert C.; Kufe, Donald W.; Pollock, Raphael E.; Weichselbaum, Ralph R.; Holland, James F.; Frei, Emil, editors.

Publisher: Canada: BC Decker Inc;

Copyright 2000.

Section 27: Neoplasms of the Head and Neck ­

86. Head and Neck Cancer ­ Treatment

2000

 

14

NOTE: The National Cancer Data Base (NCDB) report provides the largest series of acinic cell carcinoma  cases reviewed to date.

(below)

NOTE: The National Cancer Data Base (NCDB) report provides the largest series of acinic cell carcinoma cases reviewed to date.

 

 

 

Salivary gland cancers comprise between 0.3% and 0.9% of all cancers in the United States.  Acinic cell carcinomas account for approximately 5% to 11% of these salivary gland cancers.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

The largest series of salivary gland tumors to date comes from the Armed Forces Institute of Pathology (AFIP) Salivary Gland Registry, which identified acinic cell carcinoma as the third most common epithelial malignancy of the salivary glands.   In the series, acinic cell carcinoma represented 17% of primary malignant salivary gland neoplasms, and 6% of all (including benign) salivary gland neoplasms. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma. 

REFERENCING:

Armed Forces Institute of Pathology Salivary Gland Registry

Accepted Aug. 27, 1998.  Published July 1999.

unclear

unclear

Overall, survival has been crudely estimated  to be about 84%. Reported 5-year determinant (disease specific) survival ranges from 76% to 90%. These survival analyses should also be interpreted with the understanding that 10 to 20 years of follow-up is needed to identify the full impact of ACC on extended survival. Their study showed five-year survivalwas 83.3% (observed) and 91.4% (disease specific).  Worse survival was associated with high grade (p<.0001), age greater or equal to 30 years (p=.0055), and the presence of metastatic disease (p<.0001).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

STATISTICS

SOURCE

PUBLICATION DATE

TIME PERIOD STUDIED

# OF PATIENTS IN STUDY

The indolent behavior is underscored by reports that recurrent tumor has been identified up to 30 years after initial treatment.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

 

 

Previous Demographics: Most reports have identified that acinic cell carcinoma presents at an earlier age than other salivary gland cancers and affects women more commonly than men.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

 

 

 Demographics:  Income grouping reflected a disproportionately large number of cases in the high income group (12.3%) relative to the low income group (8.2%).  Cases were predominantly white non-Hispanic (86.0%).  Acinic cell carcinoma was more common in women (58.8%) than in men (41.2%) in a consistent manner across both the earlier period (1985-1990) and the later period (1991-1995).  The median age at diagnosis for both periods was approximately 52 years, with 16.2% of cases identified among patients younger than 30 years.  Women comprised a significantly larger proportion of patients in this younger group (64.4%) than in the older group (57.7%) (p=.0352).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Tumor Characteristics: The tumors arose in the parotid gland in 1167 cases (86.3%) and the submandibular gland in 37 cases (2.7%). 26 cases (1.9%) were recorded as arising within the major salivary glands, but without a specific gland identified.  Only one case was identified as arising in the sublingual gland.  The remaining 122 cases (9.0%) arose in sites other than the major salivary glands, which presumably reflect involvement of the minor salivary glands.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Tumor Characteristics:  The parotid  gland , which is dominated by serous cells and is the largest of the major salivary glands, is also the most common site of acinic cell carcinoma.  Acinic cell carcinomas are distinctly less common in the mixed serous and mucous submandibular and sublingual glands and in the predominantly mucous minor salivary glands.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Tumor Characteristics:   Although serous-type cells do not necessarily predominate in all cases, acinic cell carcinomas are commonly characterized by cytologic differentiation toward the serous acinar cells.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: The median tumor size at the time of diagnosis was 2.0 cm. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: Among cases submitted by hospitals using the 3rd and 4th editions of the AJCC staging manual: Approx. 2/3 (67.4%) of cases were Stage I.  The remainder were distributed between stage II (14.4%), stage III (11.0%), and stage IV (7.1%).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: There was insufficient data to assign extent of disease by the modified TNM classifications (ie. classified as either local, regional or distant) for 66.7% of cases.  At the time of initial presentation, disease was confined locally (Any T, N0, M0) for 88.0% of the patients who were classified by this system.  Regional metastasis (Any T, N0, M0) was identified in 9.9% of patients, and distant metastasis (Any T, Any N, M1) was identified in 2.1% of patients. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

STATISTICS

SOURCE

PUBLICATION DATE

TIME PERIOD STUDIED

# OF PATIENTS IN STUDY

Extent of Disease: Among patients for whom the modified TNM classification was known, local confinement was more commonly recorded in the later period  (1991-95) (89.5%) than in the earlier period  (1985-9)(85.2%), whereas regional spread was more commonly recorded in the 1985-90 period (11.6%) than in the 1991-95 period (9.0%).  This shift more likely reflects an artifact in the recording of information than an actual change in the tumor behavior.  The percentage of patients with unknown TNM classification decreased across these years, from 39.2% to 12.1%, and the majority of cases that were previously unknown (due to unknown metastatic status) were probably recorded as locally confined (ie. known to have no metastasis) in the 1991-1995 period.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: A significant association was identified  between the extent of detectable disease and patient age. Regional metastases, distant metastases, and large tumor size were all more common among patients 30 years of age and older (p=.0015).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: Differences in case distribution according to sex were also significant (p =.0481).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease: There were regional differences in the distribution of cases by extent of disease as well.  Regional metastases were more common among cases in the South (15.7%) and Pacific (14.0%) regions compared with the Northeast (2.4%) and Mountain (no cases) regions. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Extent of Disease:  There were no significant associations between extent of disease and race (p=.8739), income (p=.3433), and anatomic site (p=.3697).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Grade: Although the majority (67.6%) of cases were not assigned a degree of differentiation, the proportion that were graded increased from 28.3% in the earlier period to 35.6% in the later period.  Among those cases with a recorded grade, grade 1 (57.8%) was most common and grade 4 (4.6%) was least common.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Grade: Higher grade cancers were significantly associated with age 30 years or greater (p=.0024), advanced stage (p=.0002), and the presence of metatatic disease at presentation (p<.0001).  There was no association between grade and sex (p=.3061), income level (p=.4970), or region (p=.3224).  Among those cases without regional or distant metastases, there was no association between grade and tumor size analyzed by segregating cases as greater than or less than 4.0 cm (p=.1248).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Treatment:  Single modality treatment with surgery was employed in 64.0% of cases.  This proportion did not change appreciably between the earlier period (1985-90)  and the later period (1991-95). Surgery with radiotherapy was employed in 30.1% of cases.  Chemotherapy was used as adjuvant therapy along with surgery or radiotherapy in 1.0% of cases.  Among patients receiving treatment of known type, surgery (alone or with adjuvant therapy) was employed in 1285 of 1345 cases (95.0%).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Surgery:  The method of coding surgical resection did not permit analysis of extent of resection of the primary cancer.  The proportion of cases receiving a cervical lymphadenectomy remained constant, at approximately 12% across both time periods. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Lymph Nodes were confirmed as positive for metatatic disease in 36.3% of the 135 patients who were recorded as having a neck dissection with nodes examined.  Among the 448 patients identified as not receiving a lymph node dissection, 65 cases (14.5%) were identified with positive lymph nodes in the surgical specimen.    ŠThe reported incidence of regional nodal involvement may be influenced both by the availability of advanced imaging such as computed tomography (CT) and magnetic resonant imaging (MRI), as well as the criteria used to identify nodal metastases.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Metastases: Some series report an incidence of metastases  at presentation, whereas others identify an overall metastatic rate which includes recurrent cancers.  Spafford et al broadly reported cervical lymohadenopathy to be present in 10% to 15% of cases of acinic cell carcinoma.  Spiro et al in a report of 67 cases of acinic cell carcinoma treated before 1968 identified five cases (7.5%) with cervical metastases at the time of initial treatment.  An additional 6 patients were identified with subsequent cervical metastases,  for a total of 11 cases (16%) with regional metastases.  The higher incidence of cervical metastases (9.9%) identified in our study may reflect early detection of subclinical nodal disease through improved radiographic imaging with CT and MRI.  Lewis et al in another study which accrued its last patient in 1978, identified an overall regional metastatic rate of 11%, occurring either at presentation or as a recurrence among 42 patients with a median follow-up of 11 years.  Among this same group of patients, distant metastases were ultimately identified in 13%.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma .

REFERENCED ARTICLES:

Spafford PD, Mintz DR, Hay J. Acinic Cell Carcinoma of the parotid gland: review and management. Journal of Otolaryngology 1991;20:262-266.

Spiro RH, Huvos AG, Strong EW.  Acinic cell carcinoma of salivary origin; a clinicopathologic study of 67 cases.  Cancer 1978; 41: 924-935.

Lewis JE,Olsen KD, Weiland LH.  Acinic cell carcinoma: clinicopathologic review.  Cancer 1991;67: 172-179.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

and earlier in referenced papers

1353

Treatment Demographics:  Chi square analysis identified a significant association between treatment type and age (p=.0011).  Patients younger than 30 years of age were more commonly treated without adjuvant radiotherapy than patients 30 years or older.  The demographic variables of sex and income did not show statistically significant associations with specific treatment types. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma (multi-institution report).  Published : Head and Neck ­ July 1999.  Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Treatment: Although treatment type differed for the various anatomic sites, the number of cases arising in several individual sites was too small to permit statistical analysis. 

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Treatment: Advanced stage (p<.0001) and grade (p<.0001) were highly associated with the more common use of surgery and radiotherapy, when compared with lower stage and grade, which were most commonly treated with surgery alone.

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Treatment: Surgical treatment resulting in microscopic or macroscopic residual disease was more commonly treated with adjuvant radiotherapy than when surgical margins were negative (p<.0001).

National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma

Accepted Aug. 27, 1998.  Published July 1999.

1985-1995

1353

Treatment: The NCDB identifies that, across the United States, the majority of cases of acinic cell carcinoma that have either positive surgical margins, high grade, or neck metastases received radiotherapy postoperatively.  Tumor size greater than 4 cm did not impact on the proportion of cases