Triple endoscopy. A valuable procedure in head and neck surgery.

Synchronous carcinoma in the head and neck, lung, or esophagus may be identified in 10 percent of patients with squamous head and neck carcinoma by routinely performing triple endoscopy (direct laryngoscopy, bronchoscopy, and esophagoscopy) at the time of initial evaluation. In 5.5 percent of patients with squamous head and neck cancer, synchronous lung and/or esophageal cancer was identified. However, in only 1.5 percent of patients was it asymptomatic and would not have been suspected as a result of a thorough history, physical examination, and chest x-ray. The cost-effectiveness of routine triple endoscopy can be questioned, but we think it is indicated to identify those early carcinomas with an excellent chance of cure. The time and money expended to identify these early, asymptomatic cancers is small compared to that spent in treating patients with symptomatic cancer of the same organs, in whom there appears to be a much smaller chance of cure. Multiple superficial squamous carcinomas of head and neck mucosa may be managed by surgical excision, radiation therapy, laser destruction, or cryosurgery. If these methods cannot be applied, combination chemotherapy appears to provide a satisfactory alternative method of short-term control, which we believe merits further clinical investigation.