Adenosquamous Carcinoma of right Vocal Cord.. Please help... - 1258289

pattern7, I'm very sorry your father is going through such difficult treatment. I hope he is cured and get past all this. The percentages you've quoted of cure with and without radiation sound very hopeful. People with lung cancer go through adjuvant treatment for less. It's important also to balance treatment with the likeliness of lasting side effects. Generally doctors are more likely to risk more if there is a hope of cure. When there is not ability to cure the goal of cancer treatment is used to extend life and maintain or add quality to life, so you don't risk giving treatment that will unbalance that target goal.

I don't know if you've seen the other side of Grace, our information library. We have several blog posts on the subject of head and neck cancer that may be very helpful in narrowing down some of your questions. They can be found in the "focused cancer info" tab at the top of the page and here, http://cancergrace.org/hnscc/

Please look through and read any materials that may be helpful and I'll ask a doctor to comment.

Janine
forum moderator

The typical histology of vocal cord cancers is pure squamous. Adenosquamous are much, much rarer. If not already done, consultation at a major academic center with an oncologist who specializes in head/neck cancer might be a good idea. Part of a quality consult in a situation like this would be pathologic review of the surgical specimen to ensure that it really is adenosquamous.

As a rare entity, there are no major studies on adenosquamous and so it's hard to give definite prognosis numbers. In my experience and that of those mentors and colleagues that I've discussed the entity with, they tend to be more agressive than simple squamous cell cancers and tend to have worse prognosis. In my practice, I always get chest imaging (either CT or PET) to ensure that there is no spread there. There is no absolute standard of care or guidelines to say what to do and it depends a lot on the health state and values of the patient. My personal bias (weakness of words intentional--there is no standard here) is to lean towards more agressive therapy for adenosquamous than for straight up simple squamous. In a fit, motivated patient, elective neck dissection or prophylactic radiation to the neck is reasonable. The standard of care for T3N0 squamous (note that in the case you described, neck status not proven) is radiation alone, without chemo. In my practice, I do strongly consider the addition of chemo for motivated healthy patients with adenosquamous because I've seen too many recurrences without it. There's a cost in terms of side effects that is real and meaningful, but I fear this type of cancer even more than I fear chemo side effects.

Just want to let you know I'll contact Dr. Weiss for follow up.

All the very best,
Janine

Please just bear in mind that, for the second time, you have posed a rather long list of big and time consuming questions for Dr. Weiss. As we state clearly in our guidelines, we ask you to be considerate of the time of the faculty here and not pose a long list of broad questions. Can you please narrow it down to 1-2 questions that are most important to you?

-Dr. West

I'll try to narrow the focus to the key question--what to do about the neck? With the more common type of head/neck cancer, pure squamous, this would be a controversial question where options would include surgery (neck dissection) followed by consideration of adjuvant (chemo)radiotherapy (exact choice depending on what path report shows), chemoradiotherapy followed by elective neck dissection or chemoradiotherapy followed by careful observation. Adenosquamous makes things harder. First, there's less data to guide thinking. Second, the prognosis is worse, often pushing doc and patient towards more aggressive choices to try to counter that. So, again, if not already done you may wish to consider consultation with an academic multidisciplinary team who specialize in head/neck full time. I consider each of the options that I listed reasonable in my practice and I personalize my recommendation based on the values and physical strengths/weaknesses of the individual patient. The key point from an information perspective is that is important to address the neck in some way. While observation with no surgery or radiation wouldn't be crazy for a frail patient, in my practice, I would recommend some kind of treatment to the neck for T3 glottic if they were sufficiently fit and motivated. Multidisciplinary clinics can be very helpful to decision making in these tough situations.