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
Medical Instructor in the Department of Radiation Oncology
Jessica Lee
Assistant Professor of Radiation Oncology
Amanda Gilmore
Nurse Clinician
Research Results
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.
THE GRADUATE Monica Bodd, MD, MTS, with her primary Duke Surgery mentor DCI head & neck surgical oncologist Dan Rocke, MD (first image, far right) and clinic staff; at her MD Graduation with Associate Dean for Student Affairs Aimee Chung, MD (her advisory dean); and with her proud parents on graduation day.
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.
Studies in mice suggest the therapy could be a new approach to fighting lethal disease
In animal studies led by researchers atDuke Cancer Institute, a drug approved to treat leukemia successfully disrupted the ability of HER2-positive breast cancer tumors from colonizing the brain.
The finding, appearing online Aug. 30 in the journal Cell Reports, provides evidence for human trials and suggests a potential new approach to derail one of the main ways that breast cancer turns deadly.
“We have made huge strides in treating HER2-positive breast cancers, but when tumors escape the therapies, they often metastasize to the brain,” said senior authorAnn Marie Pendergast, PhD, professor and vice chair of theDepartment of Pharmacology and Cancer Biologyat Duke University School of Medicine.
“When brain metastasis occurs, treatments are unsuccessful either because the tumors have developed resistance, or the therapies cannot penetrate the blood-brain barrier,” Pendergast said. “This remains a devastating diagnosis for patients.”
Pendergast and colleagues looked at how HER2 promotes breast cancer growth, particularly after becoming resistant to targeted treatments that have been highly successful in prolonging lives. The HER2 protein is a driving force in 30% of breast cancers, with approximately 45% of these leading to brain metastases.
The researchers focused on a pair of enzymes called ABL1 and ABL2 kinases that regulate the expression of HER2. The researchers found that these kinases play a critical role in creating the conditions that allow HER2 to accumulate on the surface of breast cancer cells, fueling breast cancer tumor metastasis.
Experimenting in mice, Pendergast and her team were able to disrupt the ABL kinases using a leukemia drug called asciminib. A kinase inhibitor, the drug is not impeded by the blood-brain barrier in tumor-bearing mice and interferes with the ABL kinases’ signaling mechanism.
By blocking the ABL signaling network, the therapy keeps the HER2 protein from accumulating in the breast cancer cells and shuts down their process for fueling the proliferation and spread of cancer cells.
“These findings support the use of ABL kinase inhibitors for the treatment of HER2-positive brain metastasis,” Pendergast said.
In addition to Pendergast, study authors include Courtney M. McKernan, Aaditya Khatri, Molly Hannigan, Jessica Child, Qiang Chen, Benjamin Mayro, David Snyder, and Christopher V. Nicchitta.
The study received funding support from the Department of Defense (W81XWH-18-1-0403, W81XWH-22-10033), the National Institutes of Health (F31CA224952, F31CA243293, F99CA264162, 1R38HL143612, Q10GM101533, Q10GM118630), the National Cancer Institute (P30CA014236), and the Duke Cancer Institute and Translating Duke Health Initiative.
In Dec. 2017, Robert Russell brought donuts to the nurses on all three wards of the ninth floor of Duke Hospital — his tradition for the past three years. He says it’s the least he can do for those who saw him through the “scariest” couple weeks of his life, which began with an HPV-associated tonsil cancer diagnosis.
In December 2017 Robert Russell brought donuts to the nurses on all three wards of the ninth floor of Duke Medical Center — something he’s been doing regularly for the past three years. He started the tradition because he says it’s the least he can do for those who saw him through the “scariest” couple weeks of his life.
In July 2014, at age 52, Russell was diagnosed by Duke surgical oncologist Ramon Esclamado, MD, with advanced-stage human papilloma virus (HPV) associated squamous cell carcinoma of the oropharynx.
The oropharynx is themiddlepart of the throat, which includes the soft palate, the base of the tongue, the tonsils, and the side and back wall of the throat.
The first symptoms oforopharynx cancer are typically a lump in the neck, a sore throat and/or ear pain although oropharynx cancer can also be asymptomatic. Physicians say self-awareness and regular visits to the dentist, who does a thorough oral exam, are key to early detection.
Russell had a sore throat and had been coughing up blood for six or seven months by the time he was diagnosed. When his symptoms didn’t go away, following visits to two different primary care physicians, he had asked his wife to look down his throat.
“I think she passed out,” he recounted. “My tonsil was hanging inward and my throat was in bad shape. I went to my ENT doctor the very next day and he said he thought it was cancer, but not bad cancer, and referred me to Duke.”
