On this page you will find:
OUR Acinic Cell Carcinoma Treatment Options Overview
ACC Treatment Overviews:
Articles, Book Excerpts & Links
Salivary Gland &
Parotid Gland Cancer Treatment Overviews: Articles, Book
Excerpts & Links
(OUR) ACINIC CELL CARCINOMA
TREATMENT OPTIONS OVERVIEW:
The information provided on this website is for informational
and educational purposes only. It is not intended as a substitute for
professional health care. Any medical treatment advocated here (even if
offered by health care professionals) is offered as an opinion, and not
as licensed medical advice. The author of this overview (and the creator
of this website), is an experienced acinic cell carcinoma patient and
informed layperson, but not a physician. The reader is advised to make
decisions based on multiple information sources.
Please note: This overview has been written without a bibliography and
specific footnotes, but the opinions expressed are based on a thorough
evaluation of the literature. Consider the list of citations in the various
“Treatment” pages (as well as the Literature pages on Acinic
Cell Carcinoma, and the list of sources on the “ACC Overview”
page) as the reference sources for the material. Some opinions are additionally
based on personal and anecdotal experiences.
INTRODUCTION
Due to the rare nature of this cancer, treatment results are to some degree
anecdotal, although some larger review studies have been done. It should
be stated up front that there is no standard definitive
curative treatment for this cancer, at this time. That doesn’t mean
that there are no treatment options, or that treatments used haven’t
achieved success in many cases. It just means that they are not completely
successful all the time. It also means that new and experimental treatment
options should be considered, especially when more traditional options
are ruled out or exhausted.
There is one treatment; Fast Neutron Beam radiation,
that has proven itself to be more effective than most other forms of treatment
for this cancer, at this time, especially if certain conditions
apply. We will discuss this in more detail later.
Historically, Acinic Cell Carcinoma treatment has involved surgery (various
procedures), often with post-operative conventional radiation. Both of
these treatments have been performed with great frequency. That does not
necessarily mean that either of these modalities is the most successful
available treatment for long term control, just the most common.
That distinction is something one needs to keep in mind when making treatment
decisions, especially with rare diseases. We will explore this in more
detail below.
AN OVERALL TREATMENT “APPROACH”:
Although there is no standard curative treatment for this cancer, it can
be managed as a chronic illness over a very long time, or indefinitely.
This approach is based on diagnostics and timing. At this point, based
on current information, these are our recommendations for the best methods
for managing this cancer:
a) Be vigilant and catch any tumor sites EARLY, when they are small.
b) Treat tumors either surgically or with High LET radiation, or both,
so they are completely eradicated in that location before they get bigger
or have more time to metastasize.
c) Keep a constant watch (through various methods) for any new possible
sites for THE REST OF YOUR LIFE, and catch and treat any of them quickly
and completely.
d) Keep aware of new treatments that could be (or prove to be) applicable
for this cancer, and when appropriate, if needed, try them. To determine
what methods to try, consult with informed physicians, do your own research
on possible options and stay informed about new protocols and clinical
results.
e) Do not be lax in your vigilance. This cancer can and does recur 20-30
years later, if not sooner. Do your follow-up exams and various radiology
tests on a regular basis. Keep aware of any new symptoms or changes in
your body (that could possibly indicate new tumors), and report them to
your physician(s).
SURGERY
There are several factors to consider when deciding if a primary tumor
should be removed surgically. The primary goal of surgery is to achieve
complete tumor removal in the first surgical attempt. It
is generally accepted that complete excision results in a better prognosis,
and vice versa. If pre-operative studies indicate that surgery would likely
result in incomplete tumor removal, surgery may not be the
best approach. Specifically, if tumor location is challenging, and surgery
would result in damage to the facial nerve or other critical structures
or organs, surgery is likely not be the best possible treatment available.
If the above risks/deficits are likely, radiation therapy (specifically
with fast neutrons) has been shown to sometimes be a better
choice than surgical intervention, leaving the patients with less deficits,
and more control of disease. The idea that surgery is not necessarily
the first choice treatment for some primary salivary gland cases, may
come as a surprise to many surgeons (and oncologists), who routinely prescribe
surgery for primary head and neck tumors, without even considering other
options. It should however also be noted that, while fast neutrons have
been shown to be a quite effective treatment for ACC, they do achieve
better results with smaller tumors. So even if neutrons are indicated,
surgery is usually chosen as the first treatment modality, in order to
reduce tumor size prior to radiation treatment.
Surgery can be successful in many cases, especially when dealing with
smaller, well contained tumors. But if used as a single modality, without
any other follow-up treatment, that success, for this cancer, is often
only for limited periods of time. This is especially
true for cases of larger or more invasive tumors, where there is residual
disease, inadequate surgical margins, lymph node or nerve involvement,
or high grade histology. In most ACC cases, for long term control,
post-operative modalities should be implemented. Specifically at this
time that means radiation treatment. ..and more specifically, with fast
neutrons if possible.
Due to the slow growth and indolent nature of this cancer,
most patients are not diagnosed until they have had painless tumor growth
for several years. So by the time of diagnosis, tumors may be quite large,
and in fact may already be forming secondary tumors or metastases. Many
physicians are not aware of these realities, or other characteristics
of this cancer, largely due to the limited literature focused specifically
on this disease. So unfortunately the result is, most cases are NOT
treated as aggressively as they need to be, resulting in many more
ACC recurrences and metastases than necessary.
An important point worth noting, relative to surgical decisions, is that
it is always more beneficial to treatment decisions if tumor histology
(cancer type) is determined PRIOR to surgical intervention. A needle
biopsy/fine needle aspirate is recommended for all undiagnosed
masses, especially in the parotid gland area, so that these other treatment
options can be considered before surgery is deemed the
only option. A diagnosis of acinic cell carcinoma PRIOR to surgery can
affect treatment decisions, as detailed above.
Another school of thought proposes that acinic cell carcinoma should only
be dealt with surgically. And each recurrence or metastasis should be
dealt with individually by surgical intervention only. This avoids the
dangers of side effects associated with radiation and chemotherapy. And
it also addresses the data showing little effectiveness from chemotherapy
and recurrent poor results with conventional radiation. There is some
validity to this train of thought. However, this method does not take
into account all the possible deficits caused by radical or numerous surgical
interventions. It also does not take into account the possibility of recurrences
or metastases in inoperable areas. Our feeling at this time at ACCIC is
that some attempt at local/regional control should be made, especially
in the area of primary tumors. If successful, that local control will
hopefully provide some insurance against both local recurrences and distant
metastases.
More specific details on surgical treatment are discussed on the “Surgery”
Treatment sub page.
RADIATION THERAPY
In cases of inadequate tumor removal during surgery, suspected residual
disease/ positive margins, large primary tumors, lymph node involvement,
perineural invasion, high grade histology, or other late stage conditions,
post-operative radiation is a conventionally accepted approach.
In those cases, it is almost always recommended. Postoperatively: North
et al concluded that radiotherapy is recommended for all cases of salivary
gland cancer except for those tumors staged as T1N0 or T2N0 with low grade
histology, which were excised with negative margins. Those are reasonable
criteria. However it is also safe to say, that even in cases of complete
tumor removal, with no suspected residual disease, prophylactic use of
radiation is likely a wise course of action (if it is not contraindicated
for the individual patient.) This method has been recommended by some
experts. This treatment decision should be made on an individual basis,
with respect to such considerations as patient age, patient health other
than ACC, cosmetic concerns and so forth. If the risks do not outweigh
the potential benefits, early control of this cancer can pay off in the
long term, as ACC has a strong propensity for recurrences. The patient
may save themselves many later problems by taking greater precautions
early.
For a long time it was considered that acinic cell carcinoma was radioresistant,
and that radiation treatment was ineffective, especially in the long term.
But research since the early 1970s has shown that certain cancers (such
as salivary gland ) can be radioresistant to conventional “Low LET”
beams (photon and electron), but very responsive to “High LET”
radiation, such as Fast Neutrons. This has to do with the biological characteristics
of the cancer, including slow growth, and cell cycles. Throughout
the literature, salivary gland cancers have responded better and for longer
periods of time with Fast Neutrons than with conventional radiation.
Despite this data, conventional radiation (photon and electron) is still
the most commonly prescribed treatment for post-surgical treatment of
the disease. This is due to several factors: 1) Lack of knowledge of this
data. 2) General lack of education about fast neutrons. 3) Less availability
of fast neutron facilities. 4) Limited number of treatment slots due to
smaller number of neutron facilities. 5) Financial and logistical considerations
in treatment recommendations.
Once again, the most common treatment is not necessarily the most effective.
Unfortunately, most physicians are not aware that conventional radiation
has been proven less effective in the long term against this cancer. So
they continue to recommend photons and electrons. And in many cases, several
years later, the patients suffer the consequences of this decision, with
recurrences. In addition, patients suffer the side effects of the conventional
radiation treatment (many of them permanent), without reaping the benefits
of control of disease.
Having made the case for fast neutrons, it should also be noted that for
microscopic residual disease, or in cases of prophylactic post-operative
treatment (with no evidence of residual disease), conventional radiation
can have a valid role. It certainly HAS been shown to have advantages
in local control, as compared to surgery alone. In the setting of truly
microscopic residual disease, in low risk situations,
conventional postoperative radiotherapy gives about an 85% control rate.
This is significantly better than the control rate for surgery alone.
There is data indicating that fast neutrons ARE a more effective form of treatment in these case as well. And specifically neutrons may give more long term control. However, there has not been a randomized comparative clinical trial to compare fast neutrons with conventional radiation, in cases of microscopic residual disease. And there are other factors that come into play in the choice of treatment: The cost of fast neutrons is higher than conventional radiotherapy. There are a very limited number of neutron facilities worldwide, and even less that are greatly experienced with salivary gland treatment. So the practicalities may be, at this time, that fast neutron treatment should be reserved for more high risk cases, and tumor situations where it has shown clear advantages. In addition, there are some greater risks of side effects with fast neutrons. So it may be that in low-risk cases, conventional radiation is a more logical choice. We at ACCIC leave this decision up to the reader. We encourage you to read the enclosed literature with regards to this subject, before making a treatment decision on this point. However, in cases of inoperable tumors, inadequate tumor removal or recurrent disease, we feel the advantages of fast neutron treatment are much clearer.
It needs to be noted that there was ongoing debate (among
radiation oncologists) for many years as to the benefits of fast neutron
(High LET) treatment over conventional (Low LET) radiation. Much of the
debate was focused on the potential for more serious patient side effects
with fast neutrons. However, most of the fuel for the “anti-neutron”
argument came from early data and primitive treatment facilities. Early
fast neutron treatment was far less controlled than it can be today, especially
with modern improved delivery systems. Unfortunately the “fallout”
from some of those early arguments is still with us, and many radiation
oncologists still consider fast neutrons as either “experimental”
or “dangerous”. (Fact: Fast neutrons have been used to treat
cancer patients since the 1930s, and have been effectively used against
salivary gland cancers since the early 1970s.) A review of the literature
on fast neutron treatment for salivary gland cancers is clearly weighted
towards the effectiveness of this treatment. This does not discount the
fact that there are risks associated with all methods of radiation therapy.
And patients should discuss these risks in detail with their radiation
oncologist, and other associated health professionals, before making final
treatment decisions.
We also want to note for the record that the data for Acinic Cell Carcinoma
specifically, in relation to fast neutrons is not voluminous. Like all
research associated with this rare illness, studies rarely focus on ACC
specifically. However, in research focused on slow growing salivary gland
cancers (which ACC is the prime example of), Fast Neutrons were shown
to have more biologic effectiveness. And within numerous salivary gland
cancer studies, many ACC patients have achieved positive results with
this treatment. It is also generally considered that data for Adenoid
Cystic Carcinoma is applicable in many ways to Acinic Cell Carcinoma.
Additionally, there is quite a bit of anecdotal evidence from ACC patients
we know of. Finally, we at ACCIC are continuously in the process of collecting
more specific data on ACC and fast neutron treatment results. We will
obviously post additional data as it becomes available.
Unfortunately, the number of High Energy Fast Neutron treatment facilities
worldwide at this time is under ten. And not all of these facilities are
equipped with the same quality of treatment equipment. So the goal of
getting all acinic cell carcinoma patients properly treated with fast
neutrons, can be a challenging one. We have listed all the Fast Neutron
facilities worldwide on our “Treatment Centers and Doctor”
page. In the United States, the facility with the most experience (and
results) in treating salivary gland cancers with fast neutrons is the
University of Washington Cancer Center in Seattle. They may have the most
experience worldwide as well. Seattle has treated between 150 and 180
Acinic Cell Carcinoma cases with fast neutrons (as of 8/02).
There is also another form of High LET/Heavy Particle radiation
utilizing “Heavy Ions”. This likely has the biological
advantages of Fast Neutrons, but is a more controllable/focusable beam,
which means that there can be less damage to nearby areas you don’t
want to radiate. As of late 2004, the only two facilities utilizing Heavy
Ions for cancer patients were in Heidelberg, Germany (Darmstadt) and Chiba,
Japan. And we cannot confirm that either of these facilities is treating
ACC patients. However, it is certainly worth checking.
Once again we note, if a patient cannot be given Fast Neutrons
(or Heavy Ions) due to logistical concerns, conventional radiation should
be considered a viable second choice. In that case, accelerated
hyperfractionated dosing schedules should be strongly considered.
This is a schedule of treatments that is more frequent than “standard”
dosing schedules. Several studies on head and neck tumors have reported
significantly improved local and regional tumor control, as well improved
survival, with these schedules, as compared to conventional fractionation.
As to comparing this method with neutrons, there has not been a comparative
study between accelerated hyperfractionated photons/electrons and fast
neutrons, with regard to acinic cell carcinoma.
There are also a number of newer radiation delivery methods such as “Stereotactic
Radiotherapy”, “Gamma Knife”, “CyberKnife”,
“IMRT”, etc. which are designed to deliver higher
doses to tumors with less risk to nearby tissues and organs. Some of these
methods may also be applicable to ACC patients. And the field of radiation
oncology is an area where advances are continually being made. However
at this time, our data still indicates that High LET radiation, such as
Fast Neutron Beam has the most likelihood for long term control of this
cancer. Once there are studies to indicate otherwise, then our opinion
may change.
Our main focus in this section has been on post-operative
(or instead of operative) External Beam Radiation Therapy (also known
as “teletherapy”). And we have focused primarily
on single beam therapy discussion. There are various other radiation protocols
(or protocols involving radiation) that may have a role in acinic cell
carcinoma treatment. These options could include:
- Mixed Beam Therapy (a combination of Beams, such as photons and electrons or neutrons and electrons)
- Pre-Operative Radiation (designed to shrink the size of a tumor prior to surgery)
- Intra-Operative Radiation (performed during surgery)
(Note: At this point in time, unfortunately, Fast Neutrons are NOT being used intraoperatively.) - Brachytherapy (surgical implants of small radioactive “beads” or tubes left inside the patient)
- Combination Therapies (with chemotherapy or other drugs)
- Radiosensitizers (drugs that increase the sensitivity of cancer cells to radiation)
- Hyperthermia (use of heat to make cancer cells more sensitive to radiation)
- There are also other radiation beams that could be considered, including Proton radiation, and other heavy particle beams.
Your physician may want to consider these options
when evaluating your particular case. Once again, there is no definitive
curative treatment for this disease, so experimentation with new regimens
is encouraged. (We do suggest familiarizing oneself with the enclosed
literature first.)
It also should be noted that both surgery and radiation results have proven
most successful with smaller early-stage tumors. Radiation results with
larger tumors are often not curative. This data is primarily from conventional
radiotherapy, however fast neutrons are also less effective on larger
tumors. Therefore, at this point in time, it is considered that in most
cases, reduction of tumor size surgically, prior to neutron treatment,
is the method of choice. That is exclusive of cases where surgery would
cause significant patient deficits. In those cases, neutron treatment
alone is recommended.
In making your decisions about radiation treatment
it is important to remember that one always has to weigh the risks against
the benefits. All radiation treatments (as well as surgery, chemotherapy,
etc.) entail certain risks of side effects, both short term and permanent.
These risks need to be clearly outlined by treating physicians. And patients
need to understand them before committing to a treatment regimen. Every
patient is an individual, and each case needs to be evaluated individually
to assess whether the potential benefits outweigh the potential risks.
More details on Radiation Treatment
Options, Fast Neutrons, etc. are provided on the “Radiation”
Treatment sub page. Numerous citations are provided.
CHEMOTHERAPY
In general acinic cell carcinoma has been considered “chemo-resistant”.
In the literature, chemotherapy has mostly been found ineffective, except
for pain-relief, or partial responses, although some texts report that
it is still “under evaluation”. Data would indicate that due
to the slow metabolism of this cancer, chemotherapy of any kind is ineffective
in the long term. This may be essentially the same reason that conventional
radiation is also largely ineffective on ACC. However, since this cancer
is not widely studied by itself, one cannot say definitively that chemotherapy
is ineffective in all cases. And in fact there IS anecdotal evidence to
indicate that chemo can be effective to some degree at least, in some
situations.
While we do not know of any ACC cases of complete
response (at this time), there are cases cited of partial responses, and
tumor shrinkage. And there may be a viable role for chemo in conjunction
with other modalities, such as radiation. There may also be a new role
for chemotherapy as an angiogenesis inhibitor (blocking blood vessel growth
to tumors), which is having some success with other cancers . Utilizing
more frequent dosing schedules, some chemo drugs are being used in this
new role, with anecdotal cases of response.
It also should be kept in mind that due to the
rarity of this disease, many of the newer chemotherapy regimens may not
have been tried clinically. That also includes combination regimens with
angiogenesis inhibitors and other new biologic therapies. So, while chemotherapy
is probably not the first choice for early stage disease… For systemic
illness, aggressive disease, or metastases, we feel it certainly is a
viable option to consider at this time. This is especially the case when
we do not have a lot of other proven options available. New and experimental
regimens should be considered, if they have any indications of showing
activity in this area (with acinic cell or similar cancers).
Another point worth noting is that most of the data on acinic
cell carcinoma is based on the more common, low-grade, slow-growing variety.
It may be that treatments such as conventional chemotherapy and
conventional radiation, which are less effective on slow-growing cancers,
could be more effective on the high grade more aggressive strain.
As far as we know, this theory has not been explored in the literature,
other than in descriptions of individual cases.
More specific details on Chemotherapy are discussed on the “Chemotherapy”
Treatment sub page. You can also find information on specific chemo regimens
that may be more effective for ACC, on that page as well.
NOTE: If any acinic cell patients (or physicians) have utilized
chemotherapy for their ACC treatment, we want to hear about your
results, so we can add them to our database of information. Please either
fill out one of our surveys, or email us. Thanks!
OTHER MAINSTREAM TREATMENT OPTIONS (and
CLINICAL TRIALS)
All the previous treatment discussion has focused on the “big
three” conventional western cancer treatments; Surgery, Radiation
and Chemotherapy. While some of these have provided controlof disease
(some more than others), none of them is definitively curative. (It should
also be noted that all three deal only with the symptoms of disease, not
the causes.) The bottom line is that exploration of clinical trials and
new protocols is strongly suggested, especially for advanced cases, or
when conventional approaches have failed. One should constantly be on
the lookout for potential treatments that might prove effective against
this unusual cancer. There are always new cancer therapies being developed
or researched. However, it is very difficult, if not impossible, for patients
to be able to assess which of these myriad of therapies and alternatives
MIGHT be effective against this disease. We recommend consulting with
your physician about which clinical trials or new therapies might hold
the most promise for THIS particular cancer, and YOUR specific case.
We do provide suggestions and links to sources
(elsewhere on this website) where you can find out about clinical trials,
publications on new research, conference presentations, etc. But if you
are not a health professional, it is challenging (to say the least), to
determine which of the multitude of new treatments MIGHT be applicable
for you. Obviously if there is a new treatment for ACC or Salivary Gland
Cancers specifically, that is easier to find. But where a citation says
“Clinical Trial for Solid Tumors using SU-5416”, how do you
know if it is applicable? So if you search the resources and come up with
a list of “possible options to consider” that you can bring
to your doctor(s) for evaluation, it might spark some ideas and recommendations.
Obviously the physicians will also have their own sources of information,
and hopefully will bring ideas to the table as well.
At this point, some newer mainstream therapies
that we know (anecdotally) acinic cell carcinoma patients have tried,
include: Stereotactic Radiation and Oral Angiogenesis Inhibitors. As the
results of our website survey come in, and we learn of other treatments
tried on ACC patients, we will expand this list.
In terms of specific new therapies; The most promising areas right
now seem to be in biologic and genetic areas; targeting “overexpression”
of substances in cancer cells, targeting “growth factors”, and
targeting specific “cancer-causing” genes. Specifically, the
new family of drugs targeting growth factor receptors (such as tyrosine
kinase) are showing promise for cancer treatment in general. At this point
we do not know of any ACC patients who have tried any of these therapies.
Limited anecdotal results seem to indicate that ACC does not “overexpress”
things as much as more aggressive cancers. This would make sense. Part
of the challenge with ACC is that it “appears” to be more similar
to normal tissue than a lot of other cancers, pathologically speaking.
That makes it less aggressive, but also less easy to treat in some ways.
However, the high grade, more aggressive version of ACC may overexpress
some of these substances (such as Her2Neu, ERPR, C-Kit, RAS protein,
EGFR, PDGFR, Veg-F, etc.) that would make patients eligible for treatment
regimens targeting those factors. We STRONGLY encourage physicians
to have their ACC patients’ tissues tested for these various protocols
(and others). And please keep us informed if you find things positively
expressed in an ACC patient, as this may be useful to all of us.
It is also important to note that cancer research seems to go in waves.
A “new, promising” therapy is discovered or developed that grabs
everyone’s attention for awhile. But often, later, the clinical results
(in people) turn out not to be quite as overwhelming as the initial hype.
(Beware of TV news broadcasts touting the latest “cancer cure”.)
Also be aware that great results in mice and rats don’t necessarily
translate into great results in people.
You can find more detailed information on this subject on the “Other
Mainstream Treatment Options” and “ Clinical Trials”
Treatment sub pages.
If YOU or your ACC patient has tried any “Other Mainstream Therapies”,
please let us know by either filling out one of our Surveys, or emailing
us. Thanks.
A FEW WORDS ABOUT THE HIGH GRADE/FAST GROWING ACC
As mentioned earlier, most of the data about Acinic Cell Carcinoma treatment
(and there isn’t that much) focuses on the more common low-grade,
slow-growing strain of the disease. So generalities about effective (or
ineffective) treatments MAY not hold true for the high-grade, faster growing
variant. This strain of the disease certainly seems to behave in a completely
different manner; spreading faster, creating metastases (distant new tumors),
invading the lungs, and so forth. The pathology of the tumor tissue also
usually indicates a noticeable difference in molecular/cell structure
between the high and low grade variants (although this is not completely
reliable). Our observation is that clinically, the high grade disease
seems to behave similarly to the aggressive versions of Adenoid Cystic
Carcinoma, Mucoepidermoid Carcinoma and other head and neck cancers. So,
as stated earlier, some treatment options, such as chemotherapy, that
are ineffective on the slow-growing strain, MAY prove to be more effective
on the fast growing one.
As mentioned above, immunohistochemistry tests
are STRONGLY recommended in these cases (testing of your surgically removed
or biopsied tumor tissue in the lab). Many of the new cancer treatments
are based on “overexpression” of certain substances in tumor
material. And if these substances are overexpressed, it could make the
patient eligible for certain treatments. For example, overexpression of
Her2Neu would make one eligible for the drug Herceptin, which has been
having good clinical results for some other cancers. Tests for Her2Neu,
ERPR, C-Kit, P53, EGFR, PDGFR, RAS protein, Veg-F, C-KIT (and others as
they develop treatment protocols) are strongly recommended. These
tests are certainly worth running for ANY ACC patient, but may yield more
treatment options for the high grade variants.
ALTERNATIVE and COMPLEMENTARY THERAPIES (including Diet/Lifestyle)
There is another wide area of patient/cancer treatment that falls under
the banner of “Alternative” or “Complementary”. Over
the past decade, many therapies that previously might have been considered
“quackery” have been getting studied and evaluated by more mainstream
(conventional) medical organizations, such as the U.S. National Institute
of Health, and MD Anderson Cancer Center. In addition, many western medical
schools have initiated classes and programs integrating “alternative”
and non-conventional or non-western therapies into their curriculum. This
new period of “openness” should only serve to benefit cancer
patients. Therapies (and medications) of all kinds are being more seriously
evaluated and studied. Many anecdotal claims are being evaluated in serious
scientific trials, and validity of quoted studies are also being evaluated
in the literature. So while many treatments may be found to be worthless
(or dangerous), others may be shown to be effective or promising cancer
treatments or complementary therapies.
Another outcome of this new recognition of a
variety of treatment areas is that the lines between “conventional/mainstream”
and “alternative” are becoming grayer. Areas such as “Nutrition
and Diet”, which in the past may have had limited association with
conventional cancer treatment, may now have specialists devoted to that
field in major hospitals. This slow “graying of the lines” should
ultimately work towards the benefit of patients. Hopefully in the future,
an informed cancer doctor will be able to choose between a much wider
range of treatment options than they are able to now. Imagine a scene
where you go to visit your oncologist and he tells you that radiation
is one approach, but he wants to supplement it with Chinese herbs, and
he also wants you to take this pamphlet home on “visualization techniques”!
What should be noted however, is that while
“alternative and complementary” therapies may be available and
accessible to patients in various ways… we at ACCIC strongly recommend
doing thorough research and evaluation of any unusual/ unproven/ alternative
treatment methods, before trying anything unknown. Many therapies being
offered out there are not only unproven, but also dangerous. In addition,
most of them will take a serious toll on your wallet. And since most medical
insurance companies will not cover “alternative” therapies,
YOU will likely be paying those costs completely yourself. Unfortunately
there are many unscrupulous people out there who are seeking to make a
buck with complete disregard for the fact that they are harming cancer
patients! In the “Alternative/Complementary Options”
subpage, as well as the “General Cancer and Medical Resources
and Links” page, we provide information on how to research some
of these treatments. We should also make the point that we advocate research
and education about ALL treatments you are considering. We are not singling
out “alternative” therapies alone.
Some areas of patient treatment fall more specifically
under the category of “Complementary” than “Alternative”.
These include such things as vitamins and supplements, as well
as nutrition/diet and lifestyle. The “supplement” area of patient
health has become a booming business within the past couple decades. And
many of these methods have already made their way into the mainstream,
even if they are not always focused on by your establishment/western/conventional
physician. In our research and experience, we have found that some of
these methods hold a lot of validity for cancer patients in general, as
well as acinic cell carcinoma patients specifically. Notably, there has
been research indicating that a vitamin regimen with large amounts
of anti-oxidants can be effective in inhibiting acinic cell cancer growth.
These studies were in rats, but we believe they have validity for humans,
based on other data. Other specific supplements, such as some
Asian mushrooms, have been well studied, and shown to have significant
anti-cancer activity. A derivative (PSK) of one of these mushrooms
(Coriolus Versicolor/ Yunzhi/ Turkey Tail) is in fact one of the most
widely used anti-cancer therapies in Asia. We strongly advise patients
with acinic cell carcinoma to take the time to read the literature on
the sub pages about these subjects.
We also want to point out that the area of self-medication
with supplements has proven itself to be frustrating to many in the conventional
medical community. Over the past two decades, there has been greater and
greater access to, and widespread use of, supplements. While these are
often promoted as “natural” substances, and largely unregulated,
they are in fact just as potentially dangerous as any prescription drug.
While some of these substances have been significantly studied, many have
not. And there may be dangerous side effects to many of these supplements,
some which are completely unresearched. In addition, many of these substances
have been shown to be contraindicated in conjunction with certain mainstream
prescriptions, and be very harmful in those situations. Just like with
prescription drugs, you have to be careful when combining medications.
Our overall recommendation once again is to
carefully and thoroughly research ANY substance which you plan to ingest
or use, especially on a regular basis. And we suggest that you do that
research using reputable sources, not just pamphlets you picked up in
the health food store. We also strongly advise you to advise your physicians
about ALL medications and supplements you are taking. Some supplements
can cause bleeding during surgery, and similar undesirable situations.
Bring a complete list of your medications and supplements (including vitamins)
with you on all your doctor visits.
Under the heading of “Diet/Nutrition and Lifestyle”:
This is an area which has been studied more and more over the years in
relation to cancers of many types, as well as general health. The amount
of literature in this area is overwhelming. Since this is not our main
focus on this website, we provide an overview, and a limited amount of
citations. Obviously if we find data relevant to ACC specifically, we
will highlight it. But in terms of cancer in general, this information
is widely available from other sources (some of which we’ll provide
reference to). What we CAN say for sure is that eating LOTS of fruits
and vegetables (of different colors/types) has been well documented as
having benefits for inhibiting cancers of many types. Some data indicates
that specifically darker/richer colored fruits give even more benefits.
Either way, eating lots of fruits and veggies is probably the single most
important dietary change a cancer patient can make. Other
potential factors that have been indicated or studied in relation to inhibiting
cancer (or promoting general health) include:
- Eat LOTS of fruits and vegetables (all colors/dark
colors)
- Eat less (or no) processed foods
- Eat more organic foods without chemicals, pesticides
and hormones
- Eat less (or no) red meat (or any meat with hormones
and chemicals)
- Drink lots of clear water (and less drinks with
sugar and chemicals)
- Drink less (or no) alcohol
- Drink less (or no) caffeine
- Eat more fibre
- Eat more Omega-3 fatty acids
- Eat less dairy products (for certain cancers, not
necessarily ACC)
- Do not smoke, or hang out in environments with
secondary smoke
- Avoid any environments with known carcinogens
- Reduce stress
- Get at least 8 hours sleep per night
This is not a complete or definitive list…just a few of the more popular and accepted ideas.
Please visit our “Vitamins & Supplements”
and “Diet, Nutrition and Lifestyle” Treatment subpages for
more details on these areas.
And again, if anyone out there has tried some specific Alternative
or Complementary treatments on ACC, especially with successful results,
we would like to hear about it. Please either email us, or fill out one
of our Surveys. Thanks.
TREATMENT OVERVIEW SUMMARY
We have provided a brief overview of Acinic Cell Carcinoma treatment.
We cannot offer you a single best treatment solution (although we strongly
advised one in particular for many cases). We hope to have steered you
in a direction of more likely options to consider, as well as some to
consider rejecting. We also encourage you to make choices in the “complementary”
area that will help your body to fight the cancer. Cancer treatment is
usually not just one solution, but a combination of treatments and lifestyle
changes. We encourage you to visit the individual treatment pages, where
you can become even more informed on the details. We at ACCIC strongly
advocate completely informed patients and health professionals (BOTH).
That is why we are here.
It is paramount to remember that in choosing ANY treatment option, the
potential risks need to be weighed against the potential benefits. That
is why educating yourself on all these details is so important.
We also want to remind anyone reading this that while acinic cell carcinoma
in most cases is slow-growing and not as aggressive as many other cancers,
it also has incredible resilience. There is considerable likelihood of
recurrence (approx. 30-50% for local recurrences, and 20% for metastases).
Unlike most other cancers, these recurrences (or metastases) often happen
MANY years down the line (3-10 years is common, 20-30 years or more are
noted). So we strongly advise early aggressive treatment of the primary
tumor location, that may prevent many years of later problems.
We at ACCIC also feel that there are a few “KEYS” to more successful
treatment. We have made a checklist of sorts. This list applies to primary
tumors as well as recurrences and metastases (new growths distinct from
primary site).
SOME KEYS TO SUCCESFUL TREATMENT OF ACC:
- Catch it early.
- Catch it when it is small.
- Get it ALL when it is small and locally contained.
- Even if it is large, try and get it ALL in the primary location, before it recurs or spreads.
- Treat it in the MOST effective way possible to insure against future recurrences.
- Maintain a VIGILANT regimen of follow-ups and diagnostics so that any recurrences (local or distant) are found and treated when they are small and contained.
- Make diet, supplement and lifestyle choices to boost your immune system and help your body to fight the cancer.
- Take responsibility. Make informed decisions, utilizing information from reputable sources. Patients need to take on some of the responsibility for their treatment, especially in the case of a rare disease like ACC. Become informed so that YOU know what needs to be done for your medical care. Do not be afraid to inform others, so that your treatment is handled in the best way possible.
All the “keys” in this list require
a shared amount of responsibility by both the cancer patient and their
physicians.
The good news is that MOST of the time, acinic cell carcinoma is a low-grade
and slow growing cancer. It has been identified as the least aggressive
of the salivary gland cancers. And patients can live many many years (or
decades), especially if treated properly. Prolonged survival despite persistence
of disease is also possible. The slow growth characteristic means that
patients often have a bit of time to consider treatment options. That
is not always the case. If you have a high grade or aggressive strain
of the disease, you may need to take action very quickly. This may also
be the case if the cancer has progressed to later stages, when it is diagnosed
late (after tumors are very large), when there is lymph node involvement,
or where the cancer has metastasized (recurred in a new location).
Get the knowledge you need. Learn the history and
the data. Assess the risks and benefits. Make informed decisions. Take
responsibility.
Best of luck with all your treatment decisions!
Edgar Stroke
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