It is already 90 years since the development of rigid type bronchoscope and 22 years since the flexible bronchofiberscope was developed for the first time in the world. The role of bronchoscope has been greatly expanded these days in diagnosis and treatment of chest diseases, and the bronchoscope has become an effective weapon in its enlarged fields and methods such as the diagnosis of lung cancer, laser treatment, diagnosis, treatment, pathological and physiological researches of diffuse pulmonary diseases.
Besides, the recording method has been also improved rapidly for the images of bronchoscopic findings in the still and dynamic image processing. Particularly with the progress of electronic equipment, the development of endoscopic television system has been achieved in the T. V. endoscopes using a small size C. C. D. camera in the tip part, and very recently a bronchial T. V. endoscope has been developed with the world smallest T. V. camera in the tip part of 6. 8 mm in diameter. Furthermore, it has become possible to make clearer image of th lesions with technique of digitizing T. V. images and image processing.
The bronchoscopic diagnosis and treatment will be explained together with the new progresses in those equipments.

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Traditional Chinese Medicine (T.C.M. ) had its origins thousand years. Its theoretical guiding is the ancient Chinese philosophical thought·The theory of Yin Yang and five elements. T.C.M. has its unique theories, including distinctive anatomy, physiopathology, pharmacology and science of prescription. It treats patients with“Bian Zhen Lun Zhi” (Planning treatment according to diagnosis of the syndromes) . T.C.M. is a medical system which differs completely from the Western medicine. It is a distinctive science.
The treatment of bronchial asthma and chronic bronchitis by T.C.M. can not only relieve symptoms of acute stage, but can also prevent its recoverence by the method of tonification to Kidney Yang. Studies combining Chinese medicine with Western medicine gives further scientific clarification to T. C. M. theories.
Treating advanced pulmonary carcinoma with T.C.M. may improve its symptoms, promote the immunological function of the body and relieve the suffering and prolong life of the patients. Traditional Chinese medicine and drug may also alleviate the side-actions of chemotherapy and radiation therapy. The efficiency of T.C.M. in treating diseases of respiratory has proved doubtless.

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Management of carcinoma of the pharynx and larynx requires cooperation of the surgeon and the radiotherapist. The selection of treatment methods depends on the location, extent and growth pattern of the primary lesion, nodal status, skill of the staff, and finally the complication by treatment, physical condition and desire of patients.
In general, for early lesion, Ti or T2 without nodes, radiation therapy may be considered as the initial method of treatment. For extensive lesion, T3 or T4, the treatment of choice is planned surgery with pre-or postoperative radiation therapy. Radiation therapy not only provides excellent control of the disease for small lesions but also preserves a good function and feature in approximately 90 percent of patients. If radiation therapy fails to control the disease, patients still have another chance to be operated on. However, for an advanced case, radation therapy is initially applied as a trial. If the tumor shows marked regression after radiation of 40-50 Gy, the therapy may be continued to reach a curative dose level (about 60 -70 Gy), and surgery is reserved for salvage or for treatment of local recurrence. Salvage surgery can be performed after relatively high dose radiotherapy without unacceptable morbidity. If the tumor shows poor response after radiation of 50-60 Gy, radical surgery is recommended. The method of treatment should be selected to improve tumor control with reasonable rate of late complication or disability.

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Multiple primary cancers are increasing according to the improvement and development of cancer diagnosis and treatment. Criteria of multiple cancers and the method for evaluation whether or not the frequency of occurrence of second cancer is high compared to that by chance were briefly reviewed.
To know the risk factors for the second primary cancer, lung cancer patients with multicentric origin and laryngeal cancer patients with second malignancy were selected for case-control study. A risk of cigarette smoking was highly suggested histology-matched case-control study on multicentric lung cancer. Heavy smoking and hazardous occupation were recognized in MPC cases with lung cancer. In laryngeal cancer, the effect of smoking and drinking was suggested, but the statistical significance was not present, probably because of the overmatching between cases and controls.
Importance of education to avoid or prolong the occurrence of second cancer for the patients with high risk was discussed.

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The early cancers should be curable ones and include not only non-invasive (carcinoma in situ) but also invasive ones without wide extension. The definition of the “early cancer” should be changed with the advancement of diagnostic accuracy and therapy. In this section, important points for histological diagnosis were mentioned in order to inform attending doctors most accurately of state of the tumor concerned. The early invasive cancers derived from originally stratified squamous epithelium can often be diagnosed only at the basostromal area of the tissue. Thus, the biopsy specimens should often contain baso-stromal area for the diagnosis of early lesion. Radial intraepithelial spread of advanced cancers is the rule and should be differen tiaed from true intraepithelial cancer (CIS) . Severely dysplastic lesions should be discussed between clinicians and pathologists on the next procedures to be taken. Some intraepithelial cancers can spread deeply via the ducts of accessory glands. Some cancers, for example, small cell carcinomas of the esophagus at the early stage, may not occasionally be early cancers because of their own high malignancy. The multiplicity of cancers at early stages can exist and should be recognized by clinicians and pathologists in the bronchoesophageal field. They may be related to “field carcinogenesis”.

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Seven hundred and sixty-seven patients with laryngeal cancer were clinically and epidemiologically studied with special reference to early detection of the cancer. In the cases with carcinoma of the glottis, the average period from the onset of hoarseness to the detection of the cancer was approximately 9 months. When laryngeal cancer was detected within 3 months after the onset of hoarseness, early cancer of Ti accounted for 70% of the cases. Therefore, effective public education and mass screening are mandatory for early detection of the laryngeal cancer.
It is noteworthy that, in the cases of supraglottic cancer, sore throat and/or cough were very often the first symptoms. Sore throat was the first symptom in 62% and 28% of the cases with cancer of the epilarynx and the false cord respectively.
Second primary cancers may sometimes be the cause of death. In this study, double and triple primary cancers developed in 131 (17. 1%) and 13 (1. 7%) cases respectively. Close observation concerning second primary cancer is most advisable during the follow-up period of laryngeal cancer even after 5 years, because the incidence of second primary cancer is quite high.

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There have been 137 cases of early lung cancer in the hilar region documented in Japan. Most of these cases belonged to the high risk group had subjective symptoms and were diagnosed by sputum cytology and bronchoscopy.
The “thickening of the bronchial spur” can be the most important sign for the location of the superficial infiltrative type of early stage lung cancer in the hilar region, especially carcinoma in situ. A squamous metaplasia around the lung cancer in the hilar region was revealed by the scanning electron microscope in eight cases out of the 46 in our study.
As a method of treatment for this early stage of lung cancer in the hilar region, a lobectomy was selected. However, in order to improve the radicality of the operation and reserve for a normal lobe, a bronchoplastic procedure had to be applied.

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As there is no specific therapeutic method for“CANCER”even now, it is the most important that cancer is detected as early as possible.
For early diagnosis of the laryngeal cancer, different types of endoscopes are now used. Among them, we recommend a curved telescope for obtaining a magnified view of a part of the larynx. This scope is very effective for observing the anterior area which has a key point for us to determine a further treatment.
Generally speaking, cancer invaded membrane has a trend to become stiff. If the vocal fold is stiff, wave motion cannot be obtained on the surface of the vocal fold. Therefore, it is very important to observe the vocal fold stroboscopically during phonation. It is highly recommended that stroboscopic observation is videotaped for open demonstration and follow up study. When ordinary stroboscopy cannot be carried out for some reasons, for example, under general anesthesia, we perform a vibrator method which induces wave motion externally.
If the cancer is diagnosed on very early stage, the further treatment can be phonosurgically performed to some extent. Especially for younger patients, surgical methods are recommended rather than radiotherapy. Hence, laser surgery or cordectomy with displacement of the false vocal fold is now mainly carried out in our clinic.

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There are many cases which developed recurrence after esophagectomy for superficial esophageal carcinoma. In order to identify clinical features of ideal target of early detection of esophageal carcinoma 160 cases of superficial cancer were analyzed.
1. Depth of tumor invasion and incidence of recurrence: Lymph node metastases among mucosal carcinomas were 12% and five-year-survival rate of 13 cases was 100%. There found no recurrence among them. Lymph node metastases among submucosal carcinomas were 38% and 58% of those with lymph node metastases developed recurrence. Five-year-survival rate of submucosal carcinoma cases was 56%.
2. Gross findings of intraepithelial or mucosal carcinoma: Revised endoscopic classification of superficial esophageal carcinoma was composed of 1) O-I (superficial and protruded type), 2) O-II (superficial and flat type), 3) O-III (superficial and excavated type) and 4) O-V (superficial and unclassified type) . O-II type could be classified into a) II. (slightly elevated), b) II, (flat) and c) II, (slightly depressed) types. Ninety-six percent of intraepithelial or mucosal carcinomas were classified into O-II type (II, , 4, II, 16, II, 9) . Eighty-eight percent of submucosal carcinomas were classified into O-I, O-III and O-V.
3. Screening of O-II type lesions: Endoscopy was most successful in detection of O-II type lesions and it was facilitated by endoscopic staining methods.
Conclusion: Intraepithelial or mucosal carcinomas were estimated as ideal target for early detection of esophageal carcinoma considering their excellent prognosis. They could be identified as O-II type lesions at endoscopy. It was difficult to detect O-II lesions even by endoscopy, but endoscopic staining facilitated their detection.

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Since about 80% of the patients with the hypopharyngeal carcinoma have advanced stages (III, IV) at the first examination, the prognosis is poor (the 5-year-survival rate is only 20-30%) . Therefore, the early detection of this carcinoma is especially important.
We investigated 146 patients, treated at our hospital from 1978 to 1986; 110 pyriform sinus type (PS), 21 postcricoid type (PC), and 15 posterior wall type (PW) . For the initial symptoms, about half of the patients complained of characteristic pains of the pharynx (fairly localized pain, especially when swallowing), about 20% neck nodal swelling (i. e. already advanced stage) . There existed no definite correlation between the interval from the appearance of initial symptoms to the first examination and the stage of the disease, but most patients with stage I, II visited doctors within 3 months. About 80% of the patients visited an otolaryngologist, and about 20% visited a surgeon or a physician, for the first time. Many of the latter group had the symptom of neck nodal swelling. There were three patients whose carcinomas were detected unexpectedly by medical examination for cancer of the lung or the stomach. By the analysis of the courses of the patients, it was suggested that about 20% of the carcinomas would have been detected one-four months earlier, if examined in detail at the first visit, and about 30% detected four months earlier, if visited a doctor before the secondary symptoms appeared.
There are the following three risk factors for the carcinoma; i. e. smoking and drinking (Brinkman index=600, Sake index=60), sideropenic anemia, and radiation. Because of the very low incidence of the carcinoma, it is important to keep these factors in mind when examine the patients older than 50 years.
Sputum cytology for three cosecutive days seems to be very useful for screening the patients at risk. The positive rate was 55. 5% in Ti and 69. 6% in T2.
For the suspicious cases, the endoscopy (e. g. fiberscope with hood) must be done actively.

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Male preponderance is a common epidemiological feature in cancers of the pharynx, esophagus, larynx and lung. A rising trend is observed in cancers of the pharynx and lung. Primary prevention of these cancers is believed to be effective based on results of a largescale cohort study in Japan. Risks were commonly high in daily cigarette smokers and dependent on cigarette dose. Risks for cancers of the pharynx and esophagus were also high in daily alcohol drinkers, especially when alcohol drinking was combined with cigarette smoking. Daily consumers of green-yellow vegetables showed a significantly lowered risk for cancer of the lung.

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