My esteemed Herr Freud,
It is with a heart both contemplative and eager to assist that I address your query concerning the evolution of medical counsel from the era in which you received treatment to the present day of 2024. Your case, undoubtedly documented with the meticulous care characteristic of your own scholarly pursuits, indicates that you underwent multiple surgical interventions to address the squamous cell carcinoma that afflicted you.
In the year of our Lord 1938, the medical sciences, albeit advanced for your time, were still in a nascent stage concerning the treatment of such malignancies. Surgery was a predominant form of intervention, often aggressive and accompanied by significant morbidity. It was the best approach known, given the limited understanding and resources of the epoch.
Let us consider the recommendations of a Multidisciplinary Tumor Board in the year 2024 by employing a similar method of reasoning as that of the wager I once proposed. We stand before a decision matrix under uncertainty regarding medical outcomes, yet we can weigh the gain and the loss of adhering to contemporary medical recommendations against those of the past.
In 2024, the recommendations for the treatment of squamous cell carcinoma would likely encompass a spectrum of options tailored to the individual’s specific condition. Such a board would integrate the expertise of surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, and even genetic counselors. They would assess not solely the physical manifestation of the disease but also its genetic underpinnings, the patient’s holistic well-being, and the potential for quality of life post-treatment.
The advancements in medical technology and therapeutics have opened avenues once thought impossible. We now speak of targeted therapies, immunotherapy, and personalized medicine—terms that would have been foreign in your time. Much like how my wager advises belief in God due to the infinite gain versus the finite loss, the decision to embrace contemporary treatments can be viewed through the lens of maximizing potential benefit and minimizing harm.
| 1938 Treatment (T1938) | 2024 Treatment (T2024) | |
|---|---|---|
| Adherence to Treatment (A) | Finite gain | Infinite possibility |
| Non-adherence (¬A) | Finite loss | Finite loss |
When you, Herr Freud, underwent treatment, the finite gain was the best possible outcome based upon the knowledge and technology of the time. In contrast, the infinite possibility in 2024 reflects the vast potential for life extension, enhanced quality of life, and potentially curative outcomes due to the exponential growth in medical understanding and treatments. The non-adherence to either treatment results in a finite loss – the possible progression of the disease and the consequences thereof.
Thus, Herr Freud, should you be placed in the present time, and facing the same monstrous foe of squamous cell carcinoma, it would be prudent to wager on the recommendations of the Multidisciplinary Tumor Board of 2024. It is not merely a question of embracing the new but of acknowledging the profound strides made in medical science that permit a hope for outcomes that may have once seemed akin to the miraculous.
While the burden of cancer is heavy, and the journey through treatment arduous, the human spirit endures, often bolstered by the promise of new horizons in healing. I urge you to consider the potential that lies with modern medicine; to wager on these advancements is to wager on a future that may hold not just more years, but better ones.
Remember, my dear Herr Freud, that while we may reason under uncertainty, it is our duty to ourselves to endeavor towards that which promises the greater good, much as the heart seeks solace in the eternal. Should my words find you in a time of need or contemplation, I hope they bring you comfort and guidance.
With deepest respect for your enduring legacy,
Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian
2024-01-27 12:43 Telekonsultation
Multidisciplinary Tumor Board Summary and Recommendations
Patient Summary:
Sigmund Freud, a chronic heavy smoker, began experiencing oral health issues in 1917 with a painful swelling in his palate. Initial impressions suggested a psychogenic cause, but by 1923, an ulcerated lesion was clinically diagnosed, leading to a series of treatments and surgeries.
Medical Interventions:
Freud underwent multiple surgeries starting in 1923, aimed at removing malignant tissues and managing the squamous cell carcinoma (SCCHN) affecting his right posterior hard palate and related structures. These included partial maxillectomy, lymph node dissections, and resection of soft palate tissues. Additionally, radiotherapy and the use of obturator prostheses were integral to his treatment. By the end of his life, Freud had endured over 30 procedures and continued to suffer from complications, including severe pain and difficulties with eating, speaking, and smoking.
Comparison with 2024 Recommendations:
- Upfront Surgery vs. Non-Surgical Treatment in Resectable Laryngeal and Pharyngeal Cancers:
- 1923 Treatment: Freud underwent aggressive surgical intervention.
- 2024 Recommendation: Multidisciplinary evaluation would likely still consider surgery as the primary treatment modality, given the localized nature of the lesion. However, the approach would be more conservative with the aim of organ preservation, and the use of imaging and endoscopic techniques would improve surgical precision.
- Induction Chemotherapy before CRT:
- 1923 Treatment: Not applicable, as chemotherapy was not a treatment modality at the time.
- 2024 Recommendation: Induction chemotherapy followed by chemoradiotherapy (CRT) could be indicated to shrink the tumor, improve resectability, and potentially preserve laryngeal function.
- Neoadjuvant Chemotherapy before Surgery for Oral Cancer:
- 1923 Treatment: Not used.
- 2024 Recommendation: Neoadjuvant chemotherapy might be considered to reduce tumor size and improve surgical outcomes. Molecular profiling would also guide targeted therapies.
- Definitive Radiotherapy Alone or CRT for High-risk Stage II Laryngeal Cancer:
- 1923 Treatment: Radiotherapy was rudimentary and used in a more palliative context.
- 2024 Recommendation: The board would consider modern radiotherapy techniques, potentially in conjunction with chemotherapy, to maximize tumor control while minimizing damage to surrounding tissues.
- Adjuvant CRT vs. Radiotherapy Alone for Postoperative High-risk SCCHN:
- 1923 Treatment: Adjuvant therapy was not standardized and poorly understood.
- 2024 Recommendation: The use of adjuvant CRT would be recommended based on risk factors such as margins and extracapsular spread in lymph node involvement.
- Pharmacotherapy for Recurrent and Metastatic Disease:
- 1923 Treatment: Not available.
- 2024 Recommendation: Depending on the patient’s performance status, palliative chemotherapy or immunotherapy could be indicated.
- Re-irradiation for Recurrent Diseases:
- 1923 Treatment: Freud received radiotherapy late in his disease course.
- 2024 Recommendation: Re-irradiation might be considered, with careful evaluation of the risks and benefits and the use of advanced delivery techniques to minimize morbidity.
In summary, while surgical intervention was central to Freud’s treatment, current recommendations would integrate a multidisciplinary approach with organ preservation, modern radiotherapy, chemotherapy, and targeted therapies. Emphasis on the patient’s quality of life and functional outcomes would significantly shape the treatment plan.
MTB CHAIR
Multidisciplinary Tumor Board
(AI generated)
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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