Chemotherapy Delayed for Several Months

Case Overview

This case involves a fifty-seven-year-old female patient who developed a lump in the right upper margin of her neck at the angle of the jaw bone. The patient presented to an ENT physician who ordered a CT that showed an 18mm right buccal lesion with a solitary 17mm peri parotid metastatic node. The patient was sent for a fine needle biopsy that confirmed a well to moderately differentiated squamous cell carcinoma. Subsequently, the patient underwent a surgical resection of the buccal mucosa with a right neck dissection and a split thickness skin graft from the right thigh. The patient was staged by pathology as a T2N2B with extracapsular spread. The patient was discharged four days after surgery with no mention of external beam radiation follow-up or chemotherapy plans. Two months later, the patient was called in for follow-up scans that revealed a recurrence of cancer. At this point, it was determined that the patient had passed the window of opportunity to benefit from chemotherapy and she was now determined to be at stage four.

Questions to the Hematology expert and their responses

What would be the prognosis if radiation or chemotherapy were started after surgery?

The outcome of patients with advanced-stage cutaneous SCC is considerably worse. For patients with lymph node metastases, the five-year survival is even lower, estimated at 25-45%. Most large series in the literature have reported the risk of nodal or distant metastasis for primary tumors to be 2-6%.

About the expert

This expert has over 30 years of experience in hematology and oncology. He earned his BA from Yeshiva University, before receiving his MD from the State University of New York Downstate Medical College and his MBA from the Edinburgh Business School in Scotland. He then went on to complete two residencies in internal medicine at the New York-Presbyterian Lower Manhattan Hospital and the Hahnemann University Medical Center, respectively, followed by a fellowship in hematology and oncology at the Long Island Jewish Hillside Hospital Medical Center. Today, this expert is double board-certified in internal medicine and medical oncology. He is an active member of the American Society of Hematology and the American Society of Clinical Oncology. He has also authored 28 peer-reviewed journal articles, 10 abstracts, and 16 reviews. This expert previously served as the director of the cancer center at Generations Manhattan, as an associate professor of clinical medicine at Cornell University, as the chief of hematology and oncology and as the associate director of the cancer center at the Lincoln Medical Center, as the co-director of medical oncology and hematology at Brookdale University Hospital, and as an associate professor of medicine and the chief of hematology and oncology at the University of Medicine and Dentistry of New Jersey. Currently, he serves as an associate attending at a hospital in New York.

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Specialties:

Hematology

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