Indexing Title: RJOSON’s Medical Anecdotal Report [04-3]

MAR Title: Long Life Span of Patients with Thyroid Papillary Carcinoma and Balancing Conservative vs Radical Surgery in Cancer Patients

Date of Medical Observation: May 5, 2004

Narration:

Gavina Moscoso from Antique was a patient of mine for her papillary thyroid carcinoma. In March, 1984, the first time she consulted me at age 63, I did a total thyroidectomy, wedged resection of the esophagus, resection of the left recurrent laryngeal nerve with sternocleidomastoid myocutaneous flap. She had her first recurrence of her papillary thyroid carcinoma then. The initial operation was done in Antique in 1981 (3 years before I did my first operation on her). Because of an esophageal leak, I did a pectoralis myocutaneous flap on April 14, 1984 with subsequent resolution of the esophagocutaneous fistula.. In 1985, she had a neck node recurrence, which I excised. She had 3 neck node recurrences thereafter, in 1986, 1988, and in 1991 (she was 70 years old at this time). In all these recurrences, I just did excisions, rather than a neck dissection. The last time I saw her was in 1991. I did not see her thereafter until a relative of hers reported to me on May 5, 2004 that in 2003, Gavina died of "old age" in her sleep. Apparently, she did not die from a recurrence of her thyroid cancer. Attached is a picture given to me by the relative showing Ms. Moscoso celebrating her golden wedding anniversary in 1992.

Insights (Discovery, Stimulus, REINFORCEMENT):

1. The long life span of patients with thyroid papillary carcinoma – Ms. Moscoso lived for 22 years after her first surgery; 19 years after the first primary thyroid recurrence for which a radical surgery was done to control the primary tumor; 18 years after a neck node recurrence. This anecdotal report on the life span should temper the physicians’ usual thinking that patients over 45 to 50 have poor or poorer prognosis. It should help physicians put into proper perspective when reading published papers that say old patients have a poor or poorer perspective and therefore, should be treated with a more radical surgery.
2. The surgical management that I did shows a balancing between radical and conservative surgery in decision-making. I did a radical surgery to control the primary tumor. I did a conservative surgery on the neck node recurrence. The end-results of these decision-makings were adequate disease control and acceptable quality of life, one that had no significant numbness on the neck and shoulder pain that would usually occur after a radical neck dissection. NOTE: In the early years of my practice, my tendency in dealing with cancer that should be treated with surgery had been radical surgery. Over years, I have tempered my radical approach. If the patient’s tumor can be conservatively removed with adequate margins, then I do this. If not, I will be forced to perform radical surgery if just to be able to remove all gross tumor adequately.