American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which salivary gland tumor requires both surgical resection and radiation therapy as part of the treatment plan?

1. Pleomorphic adenoma

2. Mucoepidermoid carcinoma

3. Adenoid cystic carcinoma

4. Warthin's tumor

The correct answer is: Adenoid cystic carcinoma

Adenoid cystic carcinoma is a salivary gland tumor known for its aggressive behavior and tendency to exhibit perineural invasion. This type of cancer often requires a comprehensive treatment approach that includes both surgical resection and radiation therapy to manage the disease effectively. Surgical excision aims to remove the tumor and any surrounding tissue that may be affected. However, due to the high risk of local recurrence and potential metastasis associated with adenoid cystic carcinoma, radiation therapy is typically recommended postoperatively. This adjunctive treatment helps to eliminate residual microscopic disease and reduces the likelihood of recurrence, particularly in cases where complete surgical margins cannot be achieved. In contrast, other tumors mentioned, such as pleomorphic adenomas and Warthin's tumors, are generally more benign and can often be successfully treated with just surgical resection, with less need for additional treatments like radiation. Mucoepidermoid carcinoma can vary in behavior and treatment strategies, depending on its grade; lower-grade variants might not require radiation, while higher-grade variants could be treated more aggressively, including radiation, but it's not standard for all cases. Combining surgery with radiation therapy in the treatment plan for adenoid cystic carcinoma is crucial because of its unique characteristics and the challenges