DEAR DR. ROACH: My husband has a tumor in the right sinus of his face, and the biopsy results show that it is cancer of the salivary glands (adenoid cystic carcinoma). The oral surgeon says it will continue to grow and cause discomfort, and wants to remove part of his jaw and teeth to do reconstructive work. All this involves several weeks in the hospital and a lot of trauma. He says radiation won’t help. My husband is distrustful and says “surgeons just want to cut.” He wants to study all the options, including chemotherapy. The tumor has “migrated” into the upper roof of his mouth and is causing ear and jaw pain, as well as loosened teeth. — K.N.
ANSWER: Salivary tumors are rare, so the best treatment for them is not as well studied as it is for cancers that are more common. Ideally, a treatment plan is decided on by a combination of specialists including radiologists, pathologists, surgeons and oncologists. (This is often done by a regular meeting of a “tumor board,” who review the data from the radiologist and pathologist, and then decide on the best treatment to recommend to the patient and family). Knowing the stage of the tumor, especially whether the cancer is in the lymph nodes or has spread elsewhere, is critical when deciding the optimum treatment.
Adenoid cystic carcinomas (ACC) can be aggressive and are nearly always treated with a combination of modalities. That almost always means surgery is recommended if the disease is thought to be potentially curable. This is because the best results come in people who have as complete of a surgical resection as possible. With ACC in particular, radiation treatment is very commonly recommended as well after surgery, but radiation treatment alone is not very effective for this tumor. Chemotherapy is not part of standard treatment at this time for people with malignant salivary gland tumors unless the disease has spread at the time of diagnosis.
Your husband has extensive local disease from what you are telling me, but for the surgeon to recommend extensive surgery, it suggests the surgeon feels that, right now, the tumor is potentially curable with surgery.
DEAR DR. ROACH: I’ve been diagnosed with spinal stenosis and sciatica. I’m taking prednisone for my pain, but taking prednisone before used to be excruciating. Why does my health provider want me to stop taking prednisone now and go see a pain management specialist? I have no pain and am able to walk, sleep and work. I am aware of long-term complications. Only occasionally do I get leg cramps. I’ve gained weight, but I’m pain-free. — T.B.
ANSWER: It is the long-term complications that are the issue. Persistent use of steroids will often cause high blood pressure, diabetes and osteoporosis. The amount of prednisone and how long you take it are the most important factors in whether you’ll develop these problems.
Steroids like prednisone work by reducing inflammation, and the fact that you are pain-free on prednisone strongly suggests part of the compression of the nerve is due to inflammation. A pain management specialist might be able to inject a steroid directly into the area of inflammation and nerve compression, giving you the benefit of the steroid with much less risk.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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