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A head and neck cancer outstanding response to treatment
  1. Susana Amaral,
  2. Rita Garcia,
  3. Margarida Teixeira
  1. Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
  1. Correspondence to Dr Susana Amaral, Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra 3000-075, Portugal; amaralsmr{at}gmail.com
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http://dx.doi.org/10.1136/postgradmedj-2019-136895

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    Head and neck cancers include neoplasms from multiple sites, with different courses and variable histopathological types, although squamous cell carcinoma is by far the most common.1

    There are large geographic differences in the incidence and primary sit that reflect the prevalence of risk factors, such as tobacco and alcohol consumption, and ethnic and genetic differences among populations.

    There is often a significant delay between the initial symptoms, diagnosis and the definitive treatment which is associated with upstaging and poorer outcomes.2

    We present the case of a 46-year-old former drinker, heavy smoker man who came to our clinic with a large submental mass with exuberant inflammatory signs and skin invasion (figures 1 and 2), which had been enlarging for 8 months. He had dysphagia for solids, severe pain and a 10 kg weight loss.

    Figure 1
    Figure 1
    Figure 2
    Figure 2

    HIV testing was negative. CT showed a heterogeneous mass in the submental triangle measuring 61×57×45 mm with extension to oral cavity, causing erosion of anterior arch of the mandible, and multiple retromandibular nodes (cT4N2M0).3

    A biopsy of the mass was performed, and pathological analysis confirmed the diagnosis of squamous cell carcinoma, with origin in the oral cavity.

    The patient initiated concurrent chemoradiotherapy (69.96 Gy/33fr+cisplatin 100 mg/m2 on a three weekly basis) which was completed with acceptable tolerance and excellent tumour response (figures 3 and 4). He showed a remarkable improvement of performance status, and in the CT after treatment the tumour was considered operable so he was proposed for surgery.

    Figure 3
    Figure 3
    Figure 4
    Figure 4

    References

    1. ↵
      2. Mehanna H ,
      3. Paleri V ,
      4. West CML , et al
      . Head and neck cancer--part 1: epidemiology, presentation, and prevention. BMJ 2010;341:c4684.doi:10.1136/bmj.c4684
    2. ↵
      2. Coca-Pelaz A ,
      3. Takes RP ,
      4. Hutcheson K , et al
      . Head and neck cancer: a review of the impact of treatment delay on outcome. Adv Ther 2018;35:153–60.doi:10.1007/s12325-018-0663-7
      OpenUrl
    3. ↵
      1. American Joint Commitee on Cancer
      . Part II Head and Neck. In: AJCC cancer staging manual. 8 edn, 2016.
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    Footnotes

    • Correction notice This article has been corrected since it was published Online First. Affiliation 2 was a duplicate and has been removed.

    • Contributors SA: conceptualisation and writing—original draft presentation, review and editing. RG: review and editing. MT: final review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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