A patient has adenoid cystic carcinoma of the submandibular gland with numbness in the lower lip. MRI shows enhancement tracking along a named nerve toward the skull base. What is the critical treatment-planning implication?
Perineural spread can extend beyond the visible mass. Local control requires multidisciplinary planning that accounts for proximal nerve extent and the functional consequences of treatment.
A. Map the full neural pathway in the surgical and radiotherapy plan: Perineural spread can extend beyond the visible mass. Local control requires multidisciplinary planning that accounts for proximal nerve extent and the functional consequences of treatment.
B. Use a narrow excision around the gland only: This risks leaving subclinical neural disease.
C. Assume numbness is unrelated to the tumour: New sensory deficit is a red flag for neural involvement.
D. Offer neck dissection as the only treatment: Regional management does not replace local neural-pathway control.
E. Stop follow-up at five years: Late recurrence is recognised in adenoid cystic carcinoma.
If imaging excluded neural spread and margins were clear, local treatment volumes and morbidity discussions might differ.
Draft Clinora educational material only; not official JCIE content or clinical advice.
Back to the Section 1 bank