Be careful not to assume multiple cancerous lesions are advanced stage metastatic cancer, caution clinicians from H Plus Yangji Hospital in Seoul, and Inje University Haeundae Paik Hospital in Busan, both in the Republic of Korea. They came close to making that mistake.
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The researchers reported on a patient who was on the verge of getting only palliative care for advanced laryngeal cancer with multiple lung metastases, when in fact he was a candidate for curative-aim chemotherapy. Thanks to a “meticulous approach,” the researchers switched their plan in time.
The patient was referred to their hospital because of symptoms such as “foreign body sensation” and voice change. A smoker for 45 years, he stopped 5 years before. A physical examination revealed that lymph nodes in the neck, axillary, and inguinal areas were not enlarged. Blood count and laboratory data were all normal, but a computed tomography (CT) scan and MRI revealed that the patient had an unusual constellation of simultaneous triple primary cancers: laryngeal supraglottic cancer, small cell lung cancer (SCLC), and squamous cell lung cancer.
Head and neck cancer with synchronous or metachronous lung cancers during follow-up isn’t rare, the clinicians say. But their patient’s case is uncommon because the coexistence of SCLC and squamous cell lung cancer has rarely been reported.
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Supraglottic laryngeal cancer is usually diagnosed in the advanced stages with cervical lymph node metastasis because of its nonspecific presenting symptoms and its anatomic characteristics, including a rich lymphatic network, the researchers say. That was why at the initial presentation they presumed the patient had advanced metastatic cancer. If there had not been “high suspicion” or effort to confirm the 2 distinct lung masses by invasive diagnostic procedures, the patient would have received the expected palliative treatment and not the curative-aim treatment.
After the patient received concurrent chemoradiation therapy with weekly cisplatin, the supraglottic laryngeal cancer was “markedly decreased” without newly developed cervical lymph node metastasis. A follow-up chest CT showed partial response for the SCLC in the left upper lobe; the squamous cell lung cancer in the right lower lobe remained stable. The patient was given additional chemotherapy with etoposide and cisplatin. He has survived without recurrence.
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Source:
Kim EK, Kim JY, Kim BM, Lim SN. BMJ Case Rep. 2017;2017.
doi: 10.1136/bcr-2016-216305.
