Most patients undergo surgery to remove as much of the primary tumor as possible. The purpose of taking out the entire tumor is to reduce the probability of the tumor recurring locally at the same site or metastasizing to distant sites in the body.
Surgeons attempt to ensure that all the tumor cells are completely removed by taking out a margin of normal cells around the tumor. Pathologists analyze the tumor specimens in the middle of the surgery (“frozen sections”) as well as after the surgery. “Negative” or “clean” margins indicate that no tumor cells are visible at the outer perimeter of what the surgeon took out, while “positive” margins are not as positive an outcome. Unfortunately, even ACC patients with negative margins retain the risk of developing distant metastasis as undetectable tumor cells may already have spread prior to surgery.
ACC has a peculiar characteristic of being “neurotropic”, or being attracted to nerves. In cases where a tumor has infiltrated or wrapped around a major nerve (as often happens with facial nerves), most surgeons will seek the patient’s consent to sacrifice the nerve in order to remove all tumor cells. Nerve grafting techniques may be attempted to reduce, or possibly eliminate, the resulting partial paralysis.
There are situations in which surgery may not be appropriate or where only part of the tumor is taken out. If a tumor is near or wrapped around a vital structure such as the heart, bronchus or spine, a surgeon may be forced to leave residual disease in the patient. In addition, patients with many tumors spread throughout the lungs, for instance, do not have the option of having a surgeon remove them all.