Enormous effort using a wide variety of approaches has been made over the last three decades to transform both basic and clinical research into improved diagnoses and therapies of cancer. This brief overview summarizes new applications of tumor-associated antigens (TAAs) in cancer diagnosis and therapy. Current data suggest that antibodies or their genes against TAAs can be used to increase the tumor specificity of various diagnostic or therapeutic approaches against cancer, thereby enhancing the tumor detection rate or tumoricidal effect of each diagnosis or treatment while reducing side-effects.

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Bacterial pneumonia occurs easily in elderly people, because bacterial clearance in the bronchis and alveoli reduces with aging and/or underlying diseases. It is difficult to demonstrate latent aspiration. We should consider involvement of aspiration when elderly patients show an infiltrative shadow in the back on chest X-rays or computed tomography. Causative pathogens of aspiration pneumonia are usually anaerobes or Streptococcus pneumoniae. Gram staining is useful and prompt to detect pathogens. Clindamycin, β-lactam/β-lactamase inhibitor, and carbapenem, which are recommended by the Japanese Respiratory Society guidelines for management of community-acquired pneumonia in adults, are useful to treat aspiration pneumonia. However, fluoroquinolones are not useful because of low activity against anaerobes. There are many reports demonstrating the options in the prevention of aspiration. We should select the option which is proper for each patient based on thorough discussions.

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Since Kilian in 1893 first used the rigid endoscope and Ikeda 1964 invented the flexible bronchoscope, novel techniques have been introduced in bronchoesophagoscopy with increasing speed within the last decades. Videoendoscopy technology carries a great diagnostic potential due to optimal insight even in small diameters. PH-monitoring (PH-metry) defines GERD (gastroesophageal reflux disease) and LPR (laryngopharyngeal reflux) related diagnosis. Fiber-optic endoscopic evaluation of swallowing with sensory testing (FEESST) and transnasal esophagoscopy are new and innovative tools for non-invasive decision making. The use of light therapy for tissue destruction is highly attractive for the endoscopic and minimally invasive therapy of esophageal cancer. Photodynamic therapy (PDT) offers the possibility of palliation of advanced obstructing tumours, treatment of obstruction to an esophageal prosthesis, or eradication of early asymptomatic mucosal disease. Electrosurgery, radio-frequency systems, argon plasma coagulation (APC) and laser surgery all offer techniques, instruments, equipment and systems for resecting and destroying mucosal lesions and for hemostasis in the upper aerodigestive tract. Self-expanding metallic stents have assumed increasing importance in the palliative treatment of malignant dysphagia in recent years. Stents are also occasionally used as a last resort in benign disease. Percutaneous endoscopic tracheostomy and gastrostomy are bedside procedures for fast rehabilitation. Aim of this review is to present recent advances in the field of upper aerodigestive tract endoscopy.

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The current revolution in technology, imaging and information processing will be of major influence on bronchoscopy within the next two decades. We will be able to visualize structures in vivo that up to now only the pathologist could see, we will reach anatomic structures that are inaccessible by the bronchoscope yet, we will treat diseases that still are the domain of surgeons, medical oncologists and radiotherapists. We will be able to communicate online world wide, improving standards of patient care, teaching and finally even perform interventional procedures via networks. Due to the exponential growth of sciences like computer technology, nanotechnology and biotechnology these changes will come upon very rapidly. Also the new quality of these intelligent instruments will demand a new ideological and ethical discourse on the future of science in general.

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As per the current evidence available surgery forms the main stay in treatment of Esophageal Carcinoma. As per oncological principals radical surgery namely 3 fields and 2 fields esophagectomy, which gives chance to achieve R0 clearance. Reduces local recurrence and interns improves survival.
Radical esophagectomy has been performed in 188 of patient at the Tata Memorial Hospital from 1990 to 2000 with acceptable morbidity and mortality. The procedure helps to stage the disease properly in selected resectable patients. Initial results have shown encouraging results with 30 days operative mortality of 3.19% and leak rate about 3%. Majority of our patients i.e. 72% had node +ve.

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Patients with esophageal cancer often have multiple cancers, head and neck cancer being the most common associated cancers. We have performed otolaryngological examinations and pharyngolaryngoscopy screening in all patients with esophageal cancer prior to treatment since May 1995, when the department of otolaryngology was established in our institution. These patients also underwent examinations at discharge and every 6 months during the follow-up period.
Hypopharyngeal cancers were revealed in 60 of 1,563 esophageal cancer patients seen between May 1995 and September 2003. The TNM stages of their hypopharyngeal cancers were as follows: stage I:37, stage II:16, stage III:4, stage IV:3. Nineteen patients (stage I:16, stage II:3) were able to undergo endoscopic mucosal resection (EMR) for hypopharyngeal cancer. Three patients underwent chemotherapy after EMR because malignant tumor cells were positive at the stump or in close vicinity to the resected mucosal margin. There were no deaths related to EMR. Three patients died of other carcinomas and one died of other disease, but no patient undergoing EMR died of hypopharyngeal carcinoma.
These findings suggest that periodical examinations and pharyngolaryngoscopy screening after treatment of esophageal cancer can detect early hypopharyngeal cancers treatable with EMR, and may yield preservation of the larynx. Further investigation is necessary concerning the indications and curability of the treatment.

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Superselective arterial infusion with docetaxel and concomitant chemoradiotherapy were performed on 17 patients with hypopharyngeal cancer. For primary tumors, the total initial response rate was 100% (CR 4, PR 13), the initial complete response rate was 94.1%, and the response rate was 100%. For neck lymphnode metastasis, the initial complete response rate was 13.3% and the response rate was 80.0%. As for adverse events, grade 3 and 4 leukopenia (neutropenia) occurred in 5 cases (29.4%), grade 3 mucositis in 4 cases (23.5%), SIADH in one case, and cardiac failure in one cases. The rate of larynx preservation with this therapy was 93.3%. The two-year overall survival rate was 41.3%. The two-year survival rate for ongoing study cases was 77.9%. Based on these findings, we believe that therapeutic results are improved with this therapy. There is also a possible that this therapy may assist in larynx preservation.

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Hypopharyngeal carcinoma is one of the poorest prognosticable diseases of the head and neck. It has been shown that prognosis of patients with pN 2 or pN 3 neck metastases is especially poor and they have high incidence of uncontrolled neck recurrence and distant metastasis.
At our institute, postoperative irradiation has been performed in principle for patients with pN 2 or pN 3 neck metastases since 1998. The treatment results of 117 patients with previously untreated squamous cell carcinoma of the hypopharynx between 1998 and 2002 were analyzed and compared those of the patients from 1989 to 1998. In the cases of pN 2 and pN 3, 5-year crude survival rates went from 25% to 39%, and the overall 5-year crude survival rates changed from 32% to 46%. The regional recurrent rates in the cases of pN 2 b and pN 2 c decreased from 27% to 15%. These findings suggest that postoperative irradiation improves regional control rates and contributes to better overall prognosis for hypopharyngeal carcinoma.
In the aspect of quality of life, indications of irradiation and laryngeal preservation surgery have been extended gradually. The proportion of radiation therapy has increased from 18% to 36%, and that of laryngeal preservation surgery from 6% to 11%. Contrastingly, the proportion of total pharyngo-laryngectomies was reduced from 76% to 53%. The laryngeal preservation rate was 88% on radiation therapy and 100% with laryngeal preservation surgery. This data suggests that about half of patients with hypopharyngeal carcinoma can be treated with preservation of the larynx.

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With treatments for T2 carcinoma of the hypopharynx, although the local control rate is rather high, overall survival is not satisfactory irrespective of treatment modalities. From the point of view of quality of life (QOL), for patients with a minor hypopharyngeal lesion, such as T1 T2 cases, radiotherapy has often been selected as a first choice instead of partial pharyngectomy. In our hospitals, laser debulking surgery has been employed prior to radiotherapy in order to improve local control and to conserve the patient's QOL, if the primary lesion is exophytic and high-volume. The purpose of this study is to present the results of laser debulking surgery prior to radiotherapy for T2 carcinoma of the hypopharynx.
The subjects were 26 T2 M0 patients (23 of piriform sinus type and 3 post-cricoid). Results showed, the 5-year local control rate, 5-year larynx conservation rate and disease-specific 5-year survival rate were 92%, 92% and 96%, respectively. However, the overall 5-year survival rate was only 61%. The patients' QOL was not aggravated either during the irradiation or after treatment. These findings suggest that this procedure may be preferable for selected cases with T2 carcinoma of the hypopharynx.

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