침샘암 (Salivary Gland Cancer): Comprehensive Overview for Medical Professionals

개요 (Overview)

침샘암은 타액선에서 발생하는 악성 종양을 말합니다. 주요 침샘(귀밑샘, 턱밑샘, 혀밑샘)과 소타액선에서 발생할 수 있습니다. 다양한 조직학적 아형이 있으며, 가장 흔한 형태는 점액표피암(mucoepidermoid carcinoma)입니다.

Salivary gland cancer refers to malignant tumors arising in the salivary glands. These can occur in the major salivary glands (parotid, submandibular, sublingual) or minor salivary glands. There are various histological subtypes, with mucoepidermoid carcinoma being the most common type.

원인 (Etiology)

1. 방사선 노출 (Radiation Exposure): 머리와 목 부위의 방사선 치료.

2. 유전적 소인 (Genetic Predisposition): 가족력과 유전적 변이.

3. 바이러스 감염 (Viral Infections): 엡스타인-바 바이러스(EBV)와 사이토메갈로바이러스(CMV) 감염.

4. 직업적 노출 (Occupational Exposure): 특정 화학 물질에의 노출.

5. 흡연 (Smoking): 일부 유형의 침샘암과 연관.

6. Radiation Exposure: Radiation therapy to the head and neck area.

7. Genetic Predisposition: Family history and genetic mutations.

8. Viral Infections: Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections.

9. Occupational Exposure: Exposure to certain chemicals.

10. Smoking: Associated with some types of salivary gland cancer.

발생빈도 (Incidence)

침샘암은 두경부암 중 발생 빈도가 낮습니다. 귀밑샘에서 가장 흔하게 발생하며, 턱밑샘과 혀밑샘에서도 발생할 수 있습니다.

Salivary gland cancer is relatively rare among head and neck cancers. It most commonly arises in the parotid gland, but can also occur in the submandibular and sublingual glands.

임상증상 (Clinical Presentation)

1. 종괴 (Mass): 통증이 없거나 통증이 있는 타액선의 덩어리.

2. 안면 신경 마비 (Facial Nerve Paralysis): 특히 귀밑샘에서 발생할 때.

3. 통증 (Pain): 영향을 받는 부위의 통증.

4. 삼킴 곤란 (Dysphagia): 종양이 인접 구조물을 압박할 때.

5. 구강 건조 (Dry Mouth): 타액 분비 감소.

6. Mass: Painless or painful lump in the salivary gland.

7. Facial Nerve Paralysis: Especially when occurring in the parotid gland.

8. Pain: Pain in the affected area.

9. Dysphagia: Difficulty swallowing when the tumor compresses adjacent structures.

10. Dry Mouth: Reduced saliva production.

진단 (Diagnosis)

1. 임상 평가 (Clinical Evaluation): 철저한 두경부 검사 및 병력 청취.

2. 영상 검사 (Imaging Studies):

   • 초음파 (Ultrasound): 초기 평가 및 생검 가이드.
   • CT/MRI: 종양의 크기와 침범 범위를 평가.
   • PET/CT: 원격 전이 평가.

3. 생검 (Biopsy): 조직학적 확인을 위한 세침 흡인 생검 또는 절제 생검.

4. Clinical Evaluation: Thorough head and neck examination and history taking.

5. Imaging Studies:

   • Ultrasound: Initial assessment and biopsy guidance.
   • CT/MRI: Assess the size and extent of the tumor.
   • PET/CT: Evaluate for distant metastases.

6. Biopsy: Fine-needle aspiration biopsy or excisional biopsy for histopathological confirmation.

병리조직 (Pathology)

• 조직학적 유형 (Histological Types): 점액표피암, 선암, 소세포암, 유암종 등 다양한 아형 존재.

• 면역조직화학 (Immunohistochemistry): 종양의 기원과 특성을 확인.

• Histological Types: Mucoepidermoid carcinoma, adenocarcinoma, small cell carcinoma, adenoid cystic carcinoma, among others.

• Immunohistochemistry: To confirm the origin and characteristics of the tumor.

영상검사 소견 (Imaging Findings)

• 초음파 소견 (Ultrasound Findings): 종양의 크기와 특성을 평가.

• CT/MRI 소견 (CT/MRI Findings): 종양의 크기와 위치, 주변 조직 침범 평가.

• PET/CT 소견 (PET/CT Findings): 대사 활동을 통해 원격 전이 평가.

• Ultrasound Findings: Assess the size and characteristics of the tumor.

• CT/MRI Findings: Evaluate the size, location, and invasion of surrounding tissues by the tumor.

• PET/CT Findings: Assess metabolic activity to evaluate distant metastases.

수술 (Surgery)

• 적응증 (Indications): 대부분의 침샘암에서 1차 치료법.

• 목표 (Goal): 종양의 완전 절제 및 기능 보존.

• 기술 (Techniques): 타액선 절제술, 림프절 절제술.

• Indications: Primary treatment for most salivary gland cancers.

• Goal: Complete resection of the tumor and preservation of function.

• Techniques: Salivary gland resection, neck dissection.

방사선치료 (Radiation Therapy)

1. 적응증 (Indications): 수술 후 보조 치료, 국소 진행성 또는 재발성 질환.

2. 기술 (Techniques):

   • 강도 변조 방사선 치료(IMRT) (Intensity-Modulated Radiation Therapy): 정확한 종양 표적화.

3. 선량 (Dose):

   • 원발 종양 (Primary Tumor): 60-70 Gy.
   • 림프절 (Lymph Nodes): 50-60 Gy.

4. Indications: Adjuvant therapy post-surgery, locally advanced or recurrent disease.

5. Techniques:

   • Intensity-Modulated Radiation Therapy (IMRT): Precise tumor targeting.

6. Dose:

   • Primary Tumor: 60-70 Gy.
   • Lymph Nodes: 50-60 Gy.

항암제 (Chemotherapy)

1. 적응증 (Indications): 방사선 치료와 병행하거나 전이성 질환에 사용.

2. 약제 (Agents): 시스플라틴, 5-플루오로우라실, 독소루비신.

3. 프로토콜 (Protocols): 동시 화학방사선 치료 (CCRT), 보조 화학요법.

4. Indications: Used concurrently with radiation therapy or for metastatic disease.

5. Agents: Cisplatin, 5-fluorouracil, doxorubicin.

6. Protocols: Concurrent chemoradiotherapy (CCRT), adjuvant chemotherapy.

예후 (Prognosis)

1. 5년 생존율 (5-year Survival Rate): 약 50-70%, 아형에 따라 다름.
2. 국소 재발율 (Local Recurrence Rate): 약 20-30%.

The prognosis for salivary gland cancer varies depending on the histological subtype, with a 5-year survival rate of approximately 50-70%. The local recurrence rate is about 20-30%, indicating the need for aggressive treatment and close follow-up.

침샘암의 예후는 조직학적 아형에 따라 다르며, 5년 생존율은 약 50-70%입니다. 국소 재발율은 약 20-30%로, 공격적인 치료와 철저한 추적 관찰이 필요합니다.

참고문헌 (References)

1. Ellington, C. L., Goodman, M., Kono, S. A., Grist, W., Wadsworth, T., Chen, A. Y., & Owonikoko, T. K. (2012). Adenoid cystic carcinoma of the head and neck: incidence and survival trends based on 1973-2007 surveillance, epidemiology, and end results data. Cancer, 118(18), 4444-4451.
2. Spiro, R. H. (1997). Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head & Neck, 19(2), 92-102.
3. **Terhaard, C. H., Lubsen, H., Van der Tweel, I., Hilgers, F. J., Eijkenboom, W. M., Marres, H. A., ... & Rasch, C. R. (2005). Saliv

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침샘암 (Salivary Gland Cancer) 요약표 (Summary Table)

항목 (Item)한국어 (Korean)영어 (English)

참고문헌 (References)

1. Ellington, C. L., Goodman, M., Kono, S. A., Grist, W., Wadsworth, T., Chen, A. Y., & Owonikoko, T. K. (2012). Adenoid cystic carcinoma of the head and neck: incidence and survival trends based on 1973-2007 surveillance, epidemiology, and end results data. Cancer, 118(18), 4444-4451.
2. Spiro, R. H. (1997). Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head & Neck, 19(2), 92-102.
3. Terhaard, C. H., Lubsen, H., Van der Tweel, I., Hilgers, F. J., Eijkenboom, W. M., Marres, H. A., ... & Rasch, C. R. (2005). Salivary gland carcinoma: treatment results with radiotherapy. International Journal of Radiation OncologyBiologyPhysics, 61(1), 149-159.

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