Duke is a high-volume referral center for the treatment of head and neck cancers, which include tumors in the mouth, throat, tonsils, larynx, sinuses, neck lymph nodes, salivary glands, and thyroid gland. Duke’s head and neck cancer specialists are internationally recognized research and clinical experts who make these diseases their primary focus.
Learn more about head and neck cancer treatment at Duke
An Integrated Approach to Head and Neck Cancer Treatment
The team includes specialists in head and neck oncologic surgery, plastic and reconstructive surgery, radiation oncology, medical oncology, oral medicine, radiology, speech therapy, and pathology.
Their integrated approach to head and neck cancer treatment includes state-of-the-art surgical approaches such as transoral robotic surgery to treat tonsil, tongue, oral, and larynx cancers. These approaches incorporate the resection of the tumor while preserving speech, swallowing, and breathing functions.[DBM2] High-precision image-guided radiotherapy allows for the delivery of full doses of radiation to tumors while sparing the function of adjacent, uninvolved normal tissues.
Speech pathology, audiology, oral medicine specialists, and patient support services also play an active role in helping patients maintain quality of life throughout their treatment and recovery.
Learn more about head and neck cancer treatment at Duke
Duke head and neck cancer researchers are developing new approaches for early diagnosis that may one day eliminate the need for biopsy in collaboration with the Duke University School of Engineering. They are also conducting research to study the effect of cancer on the tumor microenvironment.
Duke radiation oncologists are investigating the use of biologically based imaging during treatment, such as 18FDG- PET/CT to identify patients with HPV-related oropharyngeal cancer who may be treated with lower doses of radiation and chemotherapy. They are also studying novel combinations of medication and stereotactic radiation therapy in patients with recurrent head and neck squamous cell cancer that cannot be surgically removed.
In January 2024, Duke University launched a celebration of its centennial — a historic opportunity to recognize Duke’s extraordinary past, communicate the impact of the present, and look toward Duke's potential impact going forward. Duke Cancer Institute, which recently celebrated its 50th anniversary as a National Cancer Institute-Designated Comprehensive Cancer Center, is proud to have hosted one of the Duke Centennial Celebration's signature events — the 2nd annual MaryAnn Black Distinguished Health Equity Symposium in honor of the late MaryAnn Black.
Duke Cancer Institute Blog
In August 2023, a team of volunteers led by Trinitia Cannon, MD (third from left), Leda Scearce, CCC-SLP, MM, MS, and Dina Abouelella, MPH, which also included Tammara Watts, MD, PhD (center) and Katharine Ciarrocca, DMD, MSEd, partnered with North Raleigh International Baptist Church and Duke Raleigh Hospital to offer head and neck cancer screenings. Dozens of families from the Cedar Creek Apartment Complex community came out for the free screenings, education, and games, and Duke Raleigh Hospital donated backpacks full of school supplies.
TheDuke University School of Medicine Department of Head and Neck Surgery & Communication Sciences (HNS&CS) recently launched Project CHECKERS (Community Head and NEck Cancer Knowledge, Engagement, Research and Screening) a Duke Cancer Institute-funded pilot project to bring head and neck cancer resources and education to the broader Durham community.
Led by DCI head and neck surgeon Trinitia Cannon, MD, an associate professor in the Department, the project will be the Department’s first community-based participatory research project and the first such head and neck cancer screening and cancer prevention education project in North Carolina.
Evolving Community Research
The Project CHECKERS team will use a mixed methodology, which includes traditional surveys and screenings as well as interviews and focus groups.
One of their community partners will be the Cedar Creek Apartment Complex community in North Raleigh. Many of these families are refugees — from at least seven different countries in Africa, Asia, and the Middle East — who speak Farsi, French, Swahili, Arabic, and other languages. They are building new lives in North Carolina, in a culture and language that is new to many of them. As is the case with many similar communities, their healthcare needs often go unmet.
The investigators believe that, compared to traditional methods, mixed-method research is an improved way to establish a community partnership, highlight gaps in the community’s knowledge and risk perception, and pave the way for successful future health interventions.
According to co-PI Nosayaba (Nosa) Osazuwa-Peters, BDS, MPH, PhD, an associate professor in the Department of Head and Neck Surgery & Communication Sciences, Project CHECKERS takes an important step in improving community engagement.
“Traditional research is very systematic, very top-down. The researchers have knowledge and decide what they believe the community needs. But these outside scientific experts do not know the values, the culture, the knowledge, or the risks inherent in that community,” he explained.
For example, traditional surveys restrict participants to answering either yes or no; for many people, that binary does not tell a complete story.
“Project CHECKERS will help us understand the lived experiences of people in these communities,” added Osazuwa-Peters. “We’ll learn about context, and we’ll learn to ask questions that allow community members to express themselves. We’ll get responses we would never get based on yes or no.”
Building a Partnership
Project CHECKERS kicked off this fall with focus groups and interviews with community members facilitated by Laura Fish, PhD, MPH, assistant professor in Family Medicine and Community Health, Duke University School of Medicine, and program director for the Behavioral Health and Survey Research Core (a DCI shared resource). An advisory board will provide feedback from both clinical and community perspectives.
Lessons learned from these conversations will help the team develop a knowledge and risk factor survey that will be administered during two head and neck cancer screening events with the community in 2024.
The CHECKERS team will also recruit providers outside the department to participate in these events to address other health concerns in the community such as primary care, mental health, and women’s health.
The long-term goal of Project CHECKERS is to show the benefits of tailoring head and neck cancer screening programs to the communities being served, and how that personalization can improve prevention, early detection, and overall survival in high-risk individuals who have limited access to care.
Noted Osazuwa-Peters, “The mixed-methods framework helps us understand not just whether an intervention works, but how, why, and for whom.”
Another plus to mixed-methods research is its appeal to community partners who might otherwise be hesitant to work with researchers.
“The design places a high value on the stories behind the numbers,” explained Cannon, “so these projects are especially attractive to community partners such as faith-based organizations, whose priority is improving practice and outcomes, more so than research and advancing knowledge.”
Project CHECKERS will provide a valuable bridge between Duke and the North Raleigh International Baptist Church (NRIBC), which ministers to a large immigrant community. NRIBC’s Pastor, Patrick Warutere, invited Duke to participate in the church’s inaugural Health and Dignity for All Fair in Raleigh in 2022. Cannon and CHECKERS co-PI Leda Scearce,CCC-SLP, MM, MS, a Duke speech pathologist and director of Community Engagement for the Department of HNS&CS, recruited nurses, medical students, and resident volunteers to provide HNC screenings for the event.
“We immediately felt a kinship with NRIBC’s Pastor Patrick Warutere and his leadership team,” shared Searce. “By the end of the day, we knew we wanted to continue to work together and set up a meeting the following week.”
Duke HNS&CS and the NRIBC team worked closely to develop the research plan and ensure that the goals and expectations of each group were aligned and transparent.
“That relationship with NRIBC has enabled us to incorporate the community’s perspectives into the development of Project CHECKERS,” said Scearce. “Our aim was to amplify the assets and expertise of the community members themselves.”
Cannon anticipates that Project CHECKERS will become a framework for future projects.
“We are looking forward to similar initiatives in hearing health for older adults, right-hemisphere stroke awareness, and more.”
Duke Cancer Institute Blog
Breast surgical oncologist and Mary and Deryl Hart Distinguished Professor of Surgery Eun-Sil Shelley Hwang, MD, MHS, with Oluwadamilola "Lola" Fayanju, MD, MA, MPHS, FACS, in early 2020.
Dr. Hwang was Chief of Breast Surgery at Duke at that time and Dr. Fayanju was an assistant professor of Surgery, Division of Surgical Oncology. Dr. Fayanju is currently Chief of the Breast Surgery Division at Penn Medicine.
THE GRADUATE Monica Bodd, MD, MTS, at her MD Graduation with Associate Dean for Student Affairs Aimee Chung, MD, her advisory dean (left); her primary Duke Surgery mentor DCI head & neck surgical oncologist Dan Rocke, MD (top right) and clinic staff; and with her proud parents on match day (bottom right).
Monica Bodd thinks a lot about the patient experience and how to make it better — both through research and clinical practice.
While earning her MD and her Masters of Theological Studies degrees at Duke, she learned from some of the best, including Thomas LeBlanc, MD, MA, MHS, Dan Rocke, MD, JD, and Walter Lee, MD, MHS, from Duke Cancer Institute, and from the Duke Divinity School, Warren Kinghorn MD, ThD, Sarah Barton OT, ThD,Susan Eastman, MDiv, PhD, and Kate Bowler, PhD.
Patient experience research in oncology is an investigation of common issues faced by people with cancer, including symptom burden, quality of life, and psychological distress, as well as how patients understand their prognosis and make decisions about their treatment through the various stages of their disease.
“The way I explain it to my friends or to my family, it’s about asking patients how they live and work through their diagnoses on a day-to-day basis, centering their perspective over the perspective of a medical record or a diagnosis or a doctor's words,” said Bodd. “There are validated and quantitative aspects to it, but it’s more about what we wouldn't necessarily capture with our big data and metrics… I believe it’s the redeeming hope for a lot of medicine.”
As Bodd was leaving Duke to begin her residency in Otolaryngology-Head & Neck Surgery at Stanford Medicine this past spring, she spoke with DCI about some of the unique projects she got to work on and co-lead as a medical student and theology student — and the wisdom and practices she’s carrying forward in her medical career from both disciplines.
Duke Cancer Institute Blog
A SERIOUS ISSUE DCI epidemiologist Nosayaba Osazuwa-Peters, PhD, MPH, BDS, an associate professor, Department of Head and Neck Surgery & Communication Sciences, and an assistant professor, Department of Population Health Sciences, studies suicide risk in head and neck cancer patients.
In 2013, shortly after Nosayaba Osazuwa-Peters, PhD, MPH, BDS, had begun work on his doctorate degree in cancer epidemiology at St. Louis University, he gave a talk to a support group for patients with head and neck cancer. He drew on his experience as a dental surgeon in his home country of Nigeria to speak about managing the side effects of head and neck cancer treatment, such as dry mouth and tissue damage from radiation.
Afterward, a patient approached him, thanked him for the talk, and said, “Doc, do you know how it feels when everything you eat tastes like cardboard?"
Osazuwa-Peters had not heard it put that way before.
Another patient at the talk said to him, “Every night I go to bed, and I just pray I don't wake up in the morning.”
As he continued to talk to these patients, it struck him that “this is the reality of a patient with head and neck cancer.”
The Duke Cancer Institute 8th Annual Scientific Retreat, held on December 3, 2021, attracted a broad array of faculty, trainees (students, residents, fellows, postdocs, etc.) and staff.For a second year, the retreat was entirely virtual and there were no poster presentations owing to the ongoing Covid-19 pandemic.“Hopefully, this will be the last time that we have to do it this way,” said executive director of DCI, Michael Kastan, MD, PhD, welcoming participants over Zoom.That it was virtual didn't stop a series of lively discussions from moving full-steam ahead on a full Friday afternoon on topics such as DCI cancer health equity and engagement strategies, viral lymphomas, bone loss as a CLL co-morbidity, ways around immune system evasion, cardio-protective cancer therapy, new approaches for treating head and neck squamous cell carcinoma, clues as to how cystic lesions progress to pancreatic cancer, unlocking immune dysfunction in glioblastoma, cholesterol-control drugs and cancer, and the PARP revolution.“We have a very full agenda today with great science from Duke trainees and faculty and are also celebrating several different anniversaries. First, it's my 10th anniversary as director of the Duke Cancer Institute and I have to say it's been a real privilege of my life to be in this role and to be able to work with such extraordinary people here. And I couldn't be more proud of everything that all the staff and all the faculty have done during the time that I've been here," said Kastan. "We're also celebrating the 50th anniversary of the National Cancer Act, which was signed in 1971, and put us down the path to NCI-designated cancer centers. The Duke Comprehensive Cancer Center (now DCI) was one of the original eight."Kastan also noted that DCI's own 50th was on the horizon."This year we begin celebrating our 50th anniversary. We've made a tremendous impact on cancer research and patient care in the U.S. and around the world.”
Duke Cancer Institute Blog
Terence Wong, MD, PhD, right, meets with a patient before his PSMA PET/CT scan. Duke is a leader in this type of imaging, which is used in combination with a radiotracer to identify if there's a druggable molecular target. (A version of this photo originally appeared in a Duke Health article in February 2022: "PSMA PET/CT Scan Improves Prostate Cancer Detection and Treatment")
The Society of Nuclear Medicine & Molecular Imaging has designated the Division of Nuclear Medicine and Radiotheranostics at Duke Health as a Comprehensive Radiopharmaceutical Therapy Center of Excellence. A national leader in radiopharmaceutical therapy (RPT), the Division is currently one of only 14 Centers in the U.S. to receive this recognition.
In addition to having technical expertise and appropriate treatment facilities, Centers must meet rigorous training, regulatory, and performance criteria, and are required to provide education and scientific contributions to this growing field. They must administer more than 40 RPT treatments per year in at least two of these disease-specific therapy areas — thyroid, neuro-endocrine tumor, and prostate.
“Duke has a long history of research and clinical experience with radiopharmaceutical therapies; dating back to the late 1990s when radio-labeled antibodies were developed at Duke by Darell Bigner (Preston Robert Tisch Brain Tumor Center) and Michael R. Zalutsky (Department of Radiology) to treat malignant brain tumors,” notes Duke Cancer Institute nuclear radiologist Terence Z. Wong, MD, PhD, FACR, chief of the Division of Nuclear Medicine and Radiotheranostics, a clinical division of Duke Radiology. “The designation as a Comprehensive Radiopharmaceutical Therapy Center of Excellence reflects the culmination of many years of teamwork.”
The Division has utilized radioiodine to treat thyroid diseases (including cancer) for decades and has been one of the leaders in the field using 131I-MIBG (a drug containing a form of radioactive iodine, also called AzedraTM and iobenguane I 131) to treat pheochromocytomas (cancer of the adrenal gland) and carcinoid tumors (a type of neuroendocrine tumor). Duke has been a national leader in treating patients with neuroendocrine tumors using LutatheraTM (177Lu-DOTATATE) since 2018, when it was approved by the FDA. More recently, Duke was one of the first cancer centers to offer PluvictoTM (177Lu-PSMA) to treat metastatic prostate cancer following its FDA approval in March 2022, and is currently the leading site in the U.S. for treating prostate cancer patients with this new radiopharmaceutical therapy.
“Large clinical trials have shown that the radiotheranostic approach can provide clinical benefit for patients with neuroendocrine tumors and prostate cancer, even in patients with advanced disease that is refractory (unresponsive) to other treatments,” explains Wong, who has a secondary faculty appointment as a professor in the Duke Department of Medicine, Division of Medical Oncology. “As a National Cancer Institute-Designated Comprehensive Cancer Center, Duke Cancer Institute is well-equipped to provide these novel treatments.”
“Radiotheranostics” is the concept of using a molecular probe directed at cancer cells to both identify and treat that cancer. Azedra, Lutathera, and Pluvicto are all delivered this way.
First the molecular probe is labeled with a small amount of radioactivity called a radiotracer, which allows the potential treatment sites to be identified by imaging. Duke has been a leader in this type of imaging; 68Ga-DOTATATE PET/CT for neuroendocrine tumors and PSMA PET/CT in prostate cancer.
If the imaging shows that the tumor cells have a druggable molecular target, the area can then be treated with the targeted radiopharmaceutical therapy using the same or similar molecular probe — delivering a high radiation dose to the specific tumor sites while sparing adjacent normal tissue.
Radiotheranostics has progressed rapidly over the last decade and is moving quickly into the mainstream of cancer therapeutics. It was this “recognition of the present and future potential of radiolabeled targeted therapy,” notes Wong, that led to the Division of Nuclear Medicine being renamed the Division of Nuclear Medicine and Radiotheranostics in 2020.