title: Carcinoma of the tonsil.
abstract: Although the experts acknowledge that there is no conclusive evidence linking secondhand smoke to head and neck cancer, a recent report by the Environmental Protection Agency classifies secondhand smoke as a group A carcinogen. There is strong evidence linking it to carcinoma of the lung. Whereas you may not be able to tell your patient that the same cause and effect is present for head and neck cancer, it is the editor's belief that this will one day be proven. Three experts agreed to treat this patient with surgery followed by full-course radiotherapy, although the surgical approaches differed. They included a marginal mandibulectomy, radical neck dissection, and plating of the remaining mandible (Dr. Strome) and a composite resection (Drs. Ward and Johnson). For reconstruction, options included a modified FAMM flap or a split-thickness skin graft (Dr. Strome), tongue flap or pectoralis major myocutaneous flap (Dr. Ward), or a split-thickness skin graft (Dr. Johnson). One consultant suggested resecting the neck mass and treating the primary tumor and neck with radiotherapy. A dental consultation is in order prior to radiotherapy (Dr. Goepfert). With regard to this woman's mental status, all the experts called for counseling. The husband should be included in the discussions (Dr. Strome and Ward) and consideration should be given to the Women's Right Advocacy Group (Dr. Johnson).
authors.affiliation: Joint Center for Otolaryngology, Harvard University, Boston, Massachusetts.
authors.forename: M
authors.initials: M
authors.lastname: Strome
authors.forename: P
authors.initials: P
authors.lastname: Ward
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.forename: H
authors.initials: H
authors.lastname: Goepfert
mesh_terms: D000368:Aged; D000437:Alcoholism; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000209:etiology / Q000628:therapy*; D005190:Family; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010146:Pain / Q000517:prevention & control; D010347:Patient Care Planning; D012907:Smoking; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014067:Tonsillar Neoplasms / Q000191:economics / Q000209:etiology / Q000628:therapy*
chemical_list: D014028:Tobacco Smoke Pollution