Adenoid Cystic Carcinoma of the Lacrimal Gland

Description
Adenoid cystic carcinoma is a type of cancer that affects glandular structures. Around the eye there is a lacrimal (lac-kree-mall) gland that makes tears. Orbital adenoid cystic carcinoma usually occurs in patients 20-50 years old.

Computed Radiographic Tomography (CT) demonstrates and Adenoid Cystic Carcinoma of the Lacrimal Gland with Orbital Extension (arrow)

Symptoms
When an adenoid cystic carcinoma of the lacrimal gland grows, it typically pushes the eye down, towards the nose and forward. It can cause bulging of the eye (called proptosis). Another characteristic of adenoid cystic carcinoma is that it also invades local nerves causing pain. Therefore, pain and proptosis are the most common symptoms of adenoid cystic carcinoma of the lacrimal gland.

Diagnosis
A complete eye examination with a clinical history and ophthalmic examination are crucial to the diagnosis of adenoid cystic carcinoma of the lacrimal gland and orbit.

CAT scans, MRI’s and ultrasounds are also helpful in determining the diagnosis of adenoid cystic carcinoma of the lacrimal gland. When the eye cancer specialist sees a well-defined tumor in the superior-temporal (upper - outer) part of the orbit, that may have eroded into adjacent bone and/or extend into the orbital apex, he or she should suspect the tumor might be an adenoid cystic carcinoma. Other tumors to consider include: benign mixed tumor, adenocarcinoma, dacryoadenitis, or other processes affecting the lacrimal gland.

Treatments
When possible, an adenoid cystic carcinoma should be totally removed. This usually requires a surgery called a lateral orbitotomy. Unfortunately, total removal is often impossible due to the tumor's size, shape, and presence of invasion. Should the adenoid cystic carcinoma be found to have a capsule, and should your doctor be able to remove it within its "capsule," surgery offers the best prognosis.

In many cases, the adenoid cystic carcinoma extends beyond the capsule. In these cases, removal of the entire adenoid cystic carcinoma may require removal of the orbital contents, bones and adjacent structures. Due to the poor (local control) results from this type of extensive surgery; combinations of surgical removal and subsequent high dose local radiation therapy are offered as an alternative. There are no comparative studies to prove if extensive surgery or surgery with subsequent radiation therapy is better for survival.

Additional Info
See "Brachy-Boost" in the Innovations Section of eyecancer.com

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