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  • Yuzo Endo, M.D., Ph.D.
  • Masahito Hitosugi, M.D., Ph.D.
  • John E. Lewis, Ph.D.

Doctor’s Health Advice

Doctor’s Health Advice

Pathologist’s advice on how to combat cancer


Cervicofacial Cancer 1

The purpose of this series of essays is to talk about adult cancer as lifestyle-related diseases and to give advice to fight against them, including the topics of chemoprevention, attitudes toward modern medicine, and importance of improving eating habits and lifestyles.

The previous essay about multiple myeloma and this essay about cervicofacial cancer were written to respond to requests by users of this website. Please note that these may not be related to the topic of lifestyle-related cancers, except for cancer of the organs related with airway such as nasopharynx, larynx and vocal cord.

Cancer of the head and neck, with exception of the central nervous system and ophthalmologic area, are treated separately by specialists of each area. For example, specialists in otolaryngology, oral surgery, upper digestive tract, and dermatologists each treat patients for cancers of that respective area. That was the trend of the medical community when I was a new physician, but over the ten years following, it became necessary to consolidate those specialty divisions for the purpose of research and treatment. Therefore, this medical arena is relatively new, and may be a trend worldwide.

Delicate detection and delicate treatment

Needless to say, the area spreading from the head to the neck includes many important systems, and let us not forget the significance of cosmetic surgery.

In general, medical surgery is not as simple as replacing parts of a machine. The many systems and tissues in this part of the body are extensively intertwined and a comprehensive diagnosis and treatment are required. Treatment of this region of the body has become increasingly in-demand because of a steadily maturing society.

The importance of the cervicofacial region

We have very important systems located in the region of the eyes through the neck. The word “system” means a group of tissues that have a specific function. Therefore “the vocal cord system” includes not only vocal cords, but also every part of the body that is concerned with vocal cords, such as nerves, nutrient vessels, and lymph vessels.

The conditions of those systems can be examined visually with modern medical equipment, which can be used to develop a detailed treatment plan. In operations, equipment such as a microscope and X ray can be used to examine a specific area. This means that the treatment area should be limited to an area as small as possible in order to preserve patients quality of life.

Diagnostic imaging technology

Along with the progress of computer technology, the efforts to capture living objects in a quantum-mechanical manner have been made,to achieve the newest diagnostic imaging technology. This is said to be the most progressive area in medicine. CT scan, MRI and PET enabled us to scan living objects by 3D images. MRI applies principles of nucleo-magnets and offers us images which are completely opposite from images delivered by X ray radiation. In images, the contents of the body can be seen as if they were composed of water, fatty tissues, and bone. Bone can be examined precisely with X ray radiation. However, soft tissue of the body consists mainly of fluid in the connective tissue, fatty tissue and muscle tissue. The technology of MRI is based on this premise and the structure of a water molecule, by applying quantum magnetic mechanics.

Magnetic behavior of atomic nucleus was substantiated in the US in 1940s. It was researched by Labi, Purcell, and Bloch, which became basic principle of NMR (nuclear magnetic resonance),who received the Nobel prize in 1940s and 1950s. They indicated two components of a nucleus, the proton and neutron, which behave like a tiny bar magnet. Hydrogen atom has only one proton and one neutron. Singular quantum magnet is essential for spin movement and influenced under the circumstances of strong magnetic field.

Majoring living objects in strong magnetic fields with the focus on nucleus of water molecule is MRI. A researcher in the US, Lauterbur, contributed to the development of this technology. After almost half of a century, MRI was brought into practical use in medicine in 1990s. He received the 10th Kyoto Prize, in the field of advanced technology.

In contrast, PET is an acronym based on the words positron, emission, and tomography. Positron is a subject in the world of positive electron called atomic elements and elemental particle. A typical atomic element consists of a nucleus and electron circulating in an orbit. Positive electrons are opposite electrons which don’t usually exist in atoms. Positron-emitting isotopes were invented and important molecules were created, such as carbon 11 and fluorine 18.

The most frequently used nuclide is FDG, a particular kind of glucose sugar. The invention of FDG was very important. Glucose sugar is a source of energy of the cell. Insulin, a kind of hormone, promotes glucose sugar uptake in the muscular cells and fatty cells by way of insulin-dependent glucose transporter. However, nerve cells in the central nervous system enable to get glucose sugar into cells without being promoted by insulin. FDG goes into cells and gets phosphorylated, and stays in cells for a relatively long time, unlike glucose sugar. In PET, this principle is applied and the interior of the body is examined with the use of FDG with fluorine releasing positron. When a positron crashes into an electron, both of them disappear and change into two gamma rays. It is important that those two gamma rays run in the opposite directions. This is a clue to determine where those rays are emitted from. In this examination, expensive equipment to detect gammarays and a mini-cyclotron for FDG are required. Cancer cells and inflammatory activated cells must consume much more FDG like glucose sugar than surrounding physiological cells, so that both cells are detected as hot spot by PET. Therefore, hot spot by PET should be re-examined further by CT scan and MRI to confirm and diagnose as cancer in order to exclude inflammatory tissue.

This equipment enables us to detect where inflammation is developing, and where the cancer cells are located, in three-dimension. Although this technology isn’t absolutely reliable, doctors can obtain the information necessary with minimal impact on the patient. These cutting-edge technologies of inspection are gradually spreading in Japan.

By applying this technology, doctors can examine what is happening in the cervicofacial region. It is important to detect and initiate treatment for cancer in early stages. In cervicofacial cancer, especially, it is required to carefully anticipate how physical function will be maintained and what kind of damages are given and left after surgery.

In the next essay, I would like to talk about cervicofacial cancer itself.


Yuzo Endo, M.D., Ph.D.

Yuzo Endo, M.D., Ph.D.
Hamamatsu University School of Medicine

1969.9: Graduated from Medical School, University of Tokyo Consultant pathologist in Hamamatsu University, Medical School, and Fujimoto General Hospital. Medical Consultant in conventional and integrative medicine.

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