Head and neck squamous cell carcinoma (HNSCC) is a common cancer in the world. Advances in treatment have improved quality of life, and there have been improvements in survival associated with human papillomavirus (HPV)-associated HNSCC. However, for typical HNSCCs associated with tobacco and alcohol use, survival rates have changed little in the last 20 years. The mortality rate remains high because of advanced and recurrent locoregional disease, as well as distant metastases. Thus, early diagnosis and treatment remains the key to improved patient survival. Better understanding of the molecular biology of early SCC is required to define relevant targets and to develop novel therapeutic approaches.
Here we illustrate the specific etiology of HNSCCs in a representative case.

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Early treatment based on early detection is important for good prognosis of oral cancer, which places a heavy responsibility on oral surgeons and dentists because of the strong relation to vital prognosis of patients. However, oral squamous cell carcinoma, the most common cancer of the oral cavity, is frequently difficult to rule out from oral mucosal lesions such as pre-cancerous lesions or conditions, especially in the early phase. Therefore, histological examination (biopsy) is widely known and used as an effective and detailed method for determining the clinical diagnosis. However, it is sometimes difficult to perform a histological examination for cases who have undergone histological examination many times, cases with little possibility of malignancy, or cases with poor general condition. We have used oral cytology (exfoliative cytology) as a helpful diagnostic method to detect oral squamous carcinoma and oral mucosal lesions. Oral cytology is easy to use for early detection for fresh cases before treatment, as well as recurrent cases in the follow-up period. Although much information is gained by cytological findings, it is a safe examination because gathering the cells is minimally invasive.
The authors have already established an examination system for detecting oral mucosal lesions and oral cancers in dental clinics in collaboration with a local dental association. In the present paper, we introduce some cases of early detectable oral cancer by this system, and report on the current situation and efficacy of the system. We also used oral cytology for mass screening for oral cancer, and report a summary of the results.

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Advances in photonics have led to a turning point in the medical field. In particular, there have been many reports on the usefulness of the diagnosis and treatment of cancers by applying specific light. In this study, we observed stage I and stage II oral squamous cell carcinomas using an endoscope with a built-in special light system (Olympus Medical Co.) and evaluated its usefulness.
1)Narrow Band Imaging (NBI): On NBI, the visibility of lesions was increased, and the magnification facilitated close observation of characteristic abnormal micro vessels (Arima's classification type 3, 4: atypical micro vessels in esophageal cancer) and mucosal changes. In addition, when the regions negative for vital iodine staining tongue squamous cell carcinoma were compared with the lesions visualized by NBI, the locations were mostly consistent.
2)Auto-Fluorescence Imaging (AFI): On AFI, the cancerous lesions were displayed with weak reddish purple auto-fluorescence, but the images were generally unclear, and dotted halation was noted. When the cross-sectioned surface of the excised specimen was observed by AFI, the depth of cancer could be observed based on differences in the auto-fluorescence intensity. On customized stereoscopic fluorescence microscopy, the cancerous lesion in the cross-sectioned surface was more clearly visible. Furthermore, a comparison of the regions observed by AFI and stereoscopic fluorescence microscope with histopathological images of the cancerous lesions showed close regional correspondence between them.
3)Infra-Red Imaging (IRI): On IRI, the pale blue color of indocyanine green (ICG) developed after ICG administration, compared to the image before administration.
Observation under these special lights may be useful for the diagnosis and treatment of oral squamous cell carcinoma, because abnormal cancerous regions are emphasized in the background of the normal region.

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Although oral cancer is relatively rare in Japan among developed countries, incidence is increasing. Therefore, there is a pressing need to develop test methods for early detection of oral cancer and to establish medical checkup systems. This study involved working with regional dental associations and performing group medical checkups for cancer for early discovery. However, there is a limit to possible regions, periods and number of people for group checkups. Checkups can be performed for only a few groups, so instead, personal medical checkups should be performed more widely in dental clinics. However, there is currently no reliable screening or inspection method that public dental clinics can easily use.
Recent research has shown that saliva has several functions to maintain and promote health, and contains biological information related to the blood and urine. Saliva can easily be collected noninvasively at any place and many times without pain. Unlike blood, saliva rarely has cell components such as erythrocytes, leukocytes and platelets, and never solidifies. Therefore, specialized toolkits can be made for the assay of abnormal proteins of targeted expression, perhaps enabling diagnosis to be made at the chair-side in dental clinics. The authors have focused on saliva which can easily be collected noninvasively many times, and have attempted to develop easy screening methods for the cancer using saliva as samples and to identify early diagnosis molecular markers by fully using proteomics analytic technology. This paper explains an outline.

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On the basis of research results of the past few decades, it is widely accepted that tumor-derived cells (CTCs) or circulating tumor-derived nucleic acids (ctNAs) found in the circulation of cancer patients might be a sign of micrometastases and thus could be an important predictor of prognosis. It is possible to estimate CTCs/ctNAs by immunocytochemical or molecular assays and these assays might also be used to monitor signs not only systemically but also in real-time in patients with malignant tumors. In this article, we discuss the transition of CTCs/ctNAs from the research setting to clinical application in oral cancer, especially our current research findings.

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[Purpose] Antiemetic therapy, used for chemotherapy-induced nausea and vomiting (CINV), is important in deciding whether to continue or terminate treatment, and improving the QOL of patients. In this study, we compared the antiemetic effect of the new fosaprepitant (Proemend^®) with that of the conventional aprepitant (Emend^®) in oral cancer patients treated with cisplatin. [Subjects and Methods] Fifteen patients who had progressive squamous cell carcinoma and were being treated with cisplatin (over 60mg/m²) chemotherapy between April 2010 and December 2012 at our Center were enrolled in the study. The evaluation of digestive symptoms was categorized following the “Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0” and “Proemend Specific Use Survey”. The presence or absence of CINV in acute and delayed phases was compared. [Result] In the acute phase, 100% of the patients in the fosaprepitant group did not vomit and 80% in the aprepitant group; 100% of the patients in the fosaprepitant group did not show nausea and 40% in the aprepitant group; thus, there was a significant difference (p = 0.022) in nausea in the acute phase. In the delayed phase, 90% of the patients in the fosaprepitant group did not vomit and 100% in the aprepitant group; 50% of the patients in the fosaprepitant group did not show nausea and 0% in the aprepitant group. [Conclusion] Although it could not be controlled with aprepitant, fosaprepitant is considered to be useful Because the occurrence of nausea and vomiting caused by cisplatin decreased with the application of fosaprepitant.

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Persistent chyle leakage occurring after neck dissection is a rare but potentially serious complication that can delay discharge from hospital, and may lead to fluid, electrolyte, protein, and immune disturbances. We describe a case of mandibular gingival cancer which we resected and our successful treatment of the persistent cervical chyle leakage by thoracoscopic thoracic duct ligation. An 80-year-old woman had pain in the left mandibular gingiva. Her condition was diagnosed as a squamous cell carcinoma of the left mandibular gingiva. As treatment, left mandibular resection, functional neck dissection, and immediate reconstruction by titanium plate and pectoralis major musculocutaneous flap were performed. Neck drainage increased suddenly on postoperative day 3 at 2000 ml. Conservative therapy and lymphatic ligation carried out more than twice were not effective. Therefore, we performed thoracoscopic thoracic duct ligation on postoperative day 20, which stopped the chyle leakage, making it possible to discharge the patient.

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The tongue flaps have proved to be an effective method of repairing defects due to tissue loss in the oral cavity. Their rich vascular supply, mobility and close proximity to the lesion (lips, palate, floor of the mouth, cheek mucosa) make the use of these flaps ideal in a variety of sites. This paper describes the use of the central island tongue flap to reconstruct defects of the mucosal surface of the upper lip. A 71-year-old man was referred to our clinic because of a painless mass on the mucosal surface of left upper lip. The tumor size, including the induration, was 20 × 16 mm. A biopsy was carried out and the pathological diagnosis was Squamous cell carcinoma. CT, MRI, US showed a neck metastasis of this carcinoma. Diagnosis: Carcinoma of the left buccal mucosa (T1N1M0, Stage III). We performed modified radical neck dissection, surgical resection of the tumor and reconstructive surgery using the tongue flap. Two weeks later we performed separation surgery of the tongue flap. The aesthetic and functional results are satisfactory one year after surgery.

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The administration of chemoradiotherapy for oral cancer by intra-arterial infusion via the superficial temporal artery could lead to excellent anti-tumor effects by introducing the anti-cancer drug at a high concentration.
We report a case of superselective intra-arterial infusion chemoradiotherapy for advanced maxillary gingival cancer using a double simultaneous catheterization method involving the maxillary artery and facial artery via the superficial temporal artery. A male patient aged 60 years old with left maxillary gingival cancer (T3N0M0) was hospitalized. The treatment protocol was as follows: five courses of radiotherapy (total dose 50Gy/25fr/5weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 75mg/m², 15mg/m²/week), CDDP (total dose: 125mg/m², 5mg/m²/day). A complete response was obtained by this therapy. The tumor has not recurred for four years, with no need for surgery. This method showed a high anti-tumor effect against advanced maxillary gingival cancer.

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