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Although tobacco and alcohol abuse are known factors in the genesis of many head and neck cancers, none of the consultants believe that the cause and effect is established in younger patients. No one is willing to make a connection between her carcinoma and her connective tissue disease. With regard to panendoscopy, the consultants would perform a rigid bronchoscopy and an esophagoscopy (Dr. Donald), laryngoscopy and esophagoscopy (Dr. Eibling), and esophagoscopy (Dr. DeSanto). (Editor's note: Bronchoscopy and/or esophagoscopy have been considered standard in the evaluation of patients with head and neck malignancies, but the editor believes there is little or no justification for endoscopy in nonsmoking young adults.) There is consensus as to how to treat this woman. The consultants concur that excision followed by radiotherapy offers the best chance for cure. On expert (Dr. Eibling) suggests that postoperative chemotherapy should also be given. Radiotherapy or chemotherapy alone are not options that anyone believes in as curative. Cure rate estimates center around 40% to 50% five-year survival (Dr. Donald) or 30% to 50% (Dr. Eibling). One physician believes it is useless to estimate the patient's odds (Dr. DeSanto). When this patient refuses surgery and stops her radiotherapy, one expert suggests waiting until the mucositis resides and proceeding with a resection (Dr. Donald). Another encourages completing the course (Dr. Eibling) and another believes there are no guidelines in such an ad-hoc program (Dr. DeSanto).(ABSTRACT TRUNCATED AT 250 WORDS) |
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