Neal Ready, MD, PhD, is a medical oncologist and researcher at Duke specializing in lung cancer and cancers of the head and neck.

Head and neck cancer includes many diseases occurring in the face, nose, tongue, tonsils, voice box, and lymph nodes.

How common is throat cancer? Is there a specific age, gender, or race that is more prone to develop this type of cancer?

Throat cancer is a type of head and neck cancer. There are about 40,000 new cases of throat cancer diagnosed each year. A very heterogeneous group of patients develop head and neck cancers so these types of cancer can affect anyone.

What are some causes of head and neck cancer?

There are two main causes:

1. Tobacco use (smoking or chewing tobacco) and alcohol use are the two primary factors.
2. In the last several decades, a growing number of throat cancers in the tonsils and back portion of the tongue have been caused by the same human papillomavirus (HPV) strains (HPV-16 and HPV-18) that cause cervical cancer.

The HPV vaccine, which is now recommended to girls to prevent contracting HPV, is active against the same strains of HPV that cause oral cancers.

It's not yet clear why some people with HPV get this throat cancer while others do not. But it does appear that decades can elapse between HPV infection and the appearance of cancer.

What are the symptoms of cancer in the head and neck?

The symptoms are common and non-specific to cancer. Patients may have a hoarse voice, pain when swallowing, sores on their tongues or in their mouths that will not heal or go away, and lymph nodes that swell and will not go away.

While these symptoms are common, if the symptoms linger for weeks, individuals should consult an ear, nose, and throat specialist.

What is the standard course of treatment for most head and neck cancers?

Throat cancer caught in its early stages can be treated with surgery or radiation.  However, most cases of throat cancer are diagnosed when the disease is locally advanced.

This means there is either a large tumor, or the cancer has spread to the surrounding lymph nodes. In those cases, there is still a chance to cure the patient of cancer.

The two standard treatment options are to surgically remove the tumor, followed by post-operative radiation or give simultaneous radiation and chemotherapy or simultaneous radiation and molecular therapy.

Even advanced stage cancers can be cured. In about five percent of patients diagnosed with throat cancer, the cancer is metastatic, meaning it has spread to other parts of the body. In those cases, we can still treat the cancer, but it is not curable.

What research is being conducted on head and neck cancer at Duke?

Radiation oncologist Dr. David Brizel is studying functional metabolic imaging with PET and MRI scans, in order to better understand how tumor blood flow and sugar utilization can be manipulated in order to treat the cancers more effectively.

Dr. Walter Lee, head and neck cancer surgeon at Duke, opened a tumor bank in which head and neck tumor specimens are stored and can be studied. He also investigates immunotherapy strategies to treat these cancers.

I just opened a stage II clinical trial using RNA and DNA analysis in order to identify specific genetic patterns of those tumors that may respond to treatment with the antibody therapy panitumuab.