A. Dimitrios Colevas
April is Head and Neck Cancer Awareness Month. We spoke to SCI member A. Dimitrios Colevas, MD to learn more about the disease.
What are the signs and symptoms of head and neck cancer?
People can feel many different things that are often associated with non-cancerous conditions which can turn out to be cancer. Hearing loss, ear fulness, feeling as if their ear is underwater, a sore throat or a bloody nose for example are extremely common in patients with cancers of the nasopharynx and oropharynx. Certainly, unexplained lumps in the neck or below the jaw can also be a first presentation of a cancer. In the oral cavity, any unexplained persistent lump, erosion, or bleeding spot is often how those cancers are first noted. In terms of the voice box or larynx, it's usually a change of voice, new cough, or difficulty breathing.
What are the risk factors and what prevention measures can be taken?
The use of tobacco products remains in the US and worldwide the biggest risk factor for head and neck cancers. Other risk factors over which patients have control are excessive alcohol consumption, working in smoky environments, or working in environments where there are heavy metals being regularly melted. Other risk factors somewhat beyond a patient’s control are exposure to Epstein-Barr Virus (EBV) which causes most nasopharynx cancer and exposure to Human Papilloma Virus also called (HPV) which is a risk factor for oropharynx cancers. The vast majority of adult humans have been exposed to both of those viruses yet only a very small fraction of those go on to develop cancer. While there is no EBV vaccine there is an HPV vaccine available for both boys and girls and it is approved up to mid-adulthood. I counsel my patients to get the word out there that these vaccinations are extremely effective and extremely safe, but they need to be given before the devolvement of cancer or exposure to HPV so the earlier in one’s life that one can get them such as the preteen years, the better.
Could you let us know about your current cancer research?
My areas of interest are somewhat divided between testing new drugs in patients with advanced disease and working with my colleagues in radiation and surgery to continue to develop better and better, safer, more effective, less toxic treatments that involve combinations of surgery radiation, and systemic therapy. In terms of the new drug realm, I’m particularly interested in nasopharynx cancer and novel ways of treating nasopharynx cancer. This cancer is largely driven by the Epstein-Barr Virus so a number of the drugs we are studying are very specifically designed to influence only those cells that are under the control of EBV. In terms of multimodality treatments, we are actively investigating new systemic therapy combinations with surgery and radiation including novel techniques of administering therapies prior to surgery or radiation. We are also investigating the use of radioactively labeled tumor-specific tags to administer to patients before surgery so we can better sort out just where the tumor is and where the tumor isn’t. It's important to reiterate these are collaborative efforts between myself, my colleagues in Medical Oncology, those in Head and Neck Surgery, and those in Radiation Oncology. We also have a very robust history of collaboration with our Dermatologic colleagues concerning the use of new drugs for squama cell carcinomas that appear in the head and neck region.
What’s the most rewarding aspect of your job?
First of all, and most importantly, the opportunity to get to know patients during a most difficult time in their life and hopefully helping them and supporting them through their cancer journey is by far the most rewarding part of my job. As an academic cancer researcher, the other aspect of my job which is incredibly rewarding is discovery. Coming to work every day and working with people who are all interested, not in merely applying present standards of care to the highest level but trying to find out and discover new better treatments is incredibly exciting.
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