Atkinson D, Fleming S, Weaver A
Am J Surg. 1982 Oct;144(4):416-9. doi: 10.1016/0002-9610(82)90414-7.
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.
在初次评估时通过常规进行三联内镜检查（直接喉镜检查、支气管镜检查和食管镜检查），可在10%的头颈部鳞状细胞癌患者中发现头颈部、肺部或食管的同步癌。在5.5%的头颈部鳞状细胞癌患者中发现了同步性肺癌和/或食管癌。然而，只有1.5%的患者无症状，并且通过全面的病史、体格检查和胸部X线检查不会被怀疑。常规三联内镜检查的成本效益可能受到质疑，但我们认为进行该项检查对于识别那些有极佳治愈机会的早期癌是有必要的。与治疗有症状的相同器官癌症患者相比，用于识别这些早期无症状癌症所花费的时间和金钱较少，而后者的治愈机会似乎要小得多。头颈部黏膜的多发性浅表鳞状细胞癌可通过手术切除、放射治疗、激光破坏或冷冻手术进行治疗。如果无法应用这些方法，联合化疗似乎可提供一种令人满意的短期控制替代方法，我们认为值得进一步进行临床研究。
