A 55-year-old male was referred to our hospital in November 2005 for odynophagia and oral bleeding.
Physical examination revealed a necrotic ulcer with a diameter of 4-5 cm in the left nostril and tonsillar pillar which was biopsied, resulting in squamous cell carcinoma.
CT showed ipsilateral laterocervical adenopathies, both submaxillary and jugular-digastric.
Blood tests and other examinations were normal.
The diagnosis of locally advanced squamous cell carcinoma of the oropharynx (T3-N2b-M0, Stage IVa) was established and chemotherapy was initiated.
Treatment consisted of hypercalcemic radiation therapy (120 cGy due to fractionated radiation therapy sessions per day, up to 7.680 cGy), and cisplatin 20 mg/m2/day for continuous infusion for 120 hours.
At the end of treatment both physical examination and CT showed complete response.
The patient remained until March 2007 when he came to our hospital for asthenia, instability and abdominal pain followed by massive embolism with asymptomatic clinical affection (Hb hematocrit 7.1g, hematocrit 21).
Gastroscopy showed an ulcerated tumor in the distal esophagus over cardia extending to greater curvature and anterior and posterior stomach.
The biopsy result was epidermoid carcinoma compatible with metastasis of laryngeal carcinoma.
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During admission several transfusions were necessary and treatment with somatostatin was initiated, although bleeding remained active.
Radiotherapy of a hemstatic nature was then initiated with 20Gy palliative sedation at a rate of 400cGy with good digestive symptoms and intention to resolve bleeding episodes.
The patient was discharged and remained asymptomatic for another 5 months after the death due to metastatic dissemination.
