My medical history, including surgery, is documented. Please write a short summary. Would the Multidisciplinary Tumor Board’s recommendations for the treatment of squamous cell carcinoma in 2024 differ from my treatment in 1938?

My esteemed colleague Sigmund Freud,

Greetings, I am Blaise Pascal, humbly at your service in these times of uncertainty and illness. Although I am not versed in the advancements of your era, I shall endeavor to offer counsel rooted in the timeless philosophy that underpins my wager on the divine.

Your legacy as the father of psychoanalysis is well documented, and I am aware that the malady which afflicts you is squamous cell carcinoma, an ailment that was beyond the scope of medicine in my own century. In your epoch, the treatment of such a condition is undoubtedly more refined than the primitive methods available to us in the seventeenth century.

The nature of your medical history is well charted. It is known that you underwent a series of surgeries to combat the malignancy in your oral cavity. These, I understand, were harrowing and caused you great discomfort and pain. The medical practices of your time, though considerably advanced from my own era, were still in the nascent stages of understanding the complexities of cancer treatment.

Now, concerning the Multidisciplinary Tumor Board’s recommendations for the treatment of squamous cell carcinoma in the year 2024: one can hypothesize that there would be stark differences when juxtaposed against the methods employed in 1938. The evolution of medical science, like all fields of human endeavor, is perpetual, driven by the insatiable human quest for knowledge and betterment of the human condition. With each passing year, the collective understanding of pathology, treatment protocols, and technology grows exponentially.

In the present day, the approach would likely be far more targeted and personalized, considering the genetic makeup of the tumor, the specific site and stage of the cancer, and the overall health and preferences of the patient. Treatments may include precision surgery, advanced radiotherapy, immunotherapy, and novel systemic treatments, all aimed at maximizing efficacy while minimizing harm.

Using the logic of Pascal’s Wager in the context of your treatment, let us consider the following: if the Multidisciplinary Tumor Board suggests a particular course of action, by following it, the potential gain could be the prolongation and improvement of life, which in this matrix is of infinite value. If the treatment does not succeed, the loss is finite, given the mortal nature of our existence. Therefore, it seems rational to follow the recommended treatment, provided the probability of benefit is non-zero.

Moreover, if you find yourself unable to believe in the potential efficacy of the new treatments, or if doubt plagues your mind, you should, as I suggested for those struggling with faith, endeavor to learn your inability to believe in the fruits of medicine and strive to convince yourself of the potential benefits. For just as believing in God provides a path to an infinitely happy life, trusting in the advances of medicine may yield a better quality of life here and now, which is an immediate gain to be treasured.

In the face of uncertainty, one must make a choice, and the rational choice is to act in a way that has the potential for the greatest gain. This is not to dismiss the value of skepticism and thorough examination but to acknowledge the limits of our understanding and the sometimes necessary leap of faith, whether in divine providence or in the hands of skilled physicians.

I offer you not only philosophical musings but also my deepest empathy. Illness can be a crucible that tests our spirits, and yet, through such trials, we may find a renewed sense of purpose and strength. May you find solace in the support of your loved ones and the skill of those who attend to your health.

In closing, may your decisions be guided by the balance of reason and hope, and may your path be illuminated by the light of progress and the wisdom of prudent action.

With respect and heartfelt wishes for your comfort and recovery,

Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian

2024-01-27 12:32 Telekonsultation

Summary of Medical History: Sigmund Freud

Sigmund Freud, the renowned psychoanalyst, had a long history of nicotine abuse and suffered from squamous cell carcinoma of the head and neck (SCCHN). Despite cardiac issues earlier in life, his cancer journey began notably in 1923 with an ulcerated lesion in his right posterior hard palate. After an initial inadequate excisional biopsy by Dr. Hans Hajek, Freud underwent a series of operations by Dr. Hans Pichler, which included partial resections of his maxilla and mandible, and removal of lymph nodes. Despite these interventions, Freud faced multiple recurrences of the cancer.

Freud underwent a total of five major surgeries for his SCCHN, with extensive postoperative care, including the creation and management of an obturator prosthesis to compensate for the maxillectomy defect. His treatments were accompanied by periods of radiotherapy, which were the standard of care at the time.

Pain management was a significant component of his treatment, increasingly so towards the end of his life, concluding with his death in 1939 aided by euthanasia upon his request due to intractable pain and suffering.

Multidisciplinary Tumor Board Recommendations for SCCHN in 2024:

1. Upfront Surgery or Non-Surgical Treatment in Resectable Laryngeal and Pharyngeal Cancers:
   The decision regarding upfront surgery versus non-surgical treatment methods such as chemoradiotherapy (CRT) often depends on factors including tumor stage, site, patient’s general health, and preference. In 2024, organ preservation strategies and functional outcomes are heavily emphasized, often favoring non-surgical treatments when possible and appropriate.

2. Indications for Induction Chemotherapy Before CRT:
   Induction chemotherapy is considered in cases where tumor burden reduction may improve the success of CRT, particularly in advanced-stage cancers. It aims to improve distant control and potentially preserve laryngeal function. This was not an available intervention during Freud’s time.

3. Indication for Neoadjuvant Chemotherapy Before Surgery for Oral Cancer:
   Neoadjuvant chemotherapy is typically indicated for locally advanced oral cancers to shrink the tumor before surgery, potentially enabling a less extensive surgical procedure and improving surgical outcomes.

4. Definitive Radiotherapy Alone or CRT for High-Risk Stage II Laryngeal Cancer:
   High-risk stage II laryngeal cancers may be treated with definitive radiotherapy alone or in combination with chemotherapy, based on specific risk features and patient comorbidities. CRT might offer better local control and organ preservation.

5. Adjuvant CRT or Radiotherapy Alone for Postoperative High-Risk SCCHN:
   In cases with high-risk features postoperatively (e.g., positive margins, extracapsular spread), adjuvant CRT is often recommended to improve locoregional control and survival. Radiotherapy alone may be considered for lower-risk cases.

6. Pharmacotherapy Indication for Recurrent and Metastatic Disease:
   Pharmacotherapy, including targeted agents and immunotherapy, is indicated for recurrent or metastatic SCCHN, which could offer significant survival benefits and was not an option in Freud’s era.

7. Risks and Benefits of Re-Irradiation for Recurrent Diseases:
   Re-irradiation is considered for recurrent SCCHN, although it comes with increased risks of toxicity. The benefits must be carefully weighed against the potential for severe adverse effects, especially in a previously irradiated field.

Conclusion:

The treatment recommendations for SCCHN have evolved considerably since Freud’s time. Modern treatment emphasizes a balance between oncologic control and quality of life, with advancements in chemotherapy, targeted therapy, and immunotherapy, as well as more precise radiotherapy techniques and supportive care measures. These advancements would likely have altered the approach to Freud’s treatment had they been available during his lifetime.

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

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

© 2023 Eurodoc Telemedizin ForschungsgesellschaftmbH