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Keck School researchers seek to improve outcomes for head and neck cancers

Keck School of Medicine of USC researchers are trying to take away some of head and neck cancer’s malevolent bite.

When caught early, most head and neck cancers are highly curable. Once they spread, the chance of survival drops precipitously. So Keck School researchers are studying what makes the cancers spread—and how to stop them.

They also have launched projects to understand why some cancers recur and how to make the cancer cells more sensitive to radiation therapy. At the same time, they are testing ways to protect the muscles from the damaging side effects of radiotherapy.

Uttam Sinha, associate professor, chief and program director of the Department of Otolaryngology/Head and Neck Surgery, oversees the translational research efforts and works closely with Rizwan Masood, assistant professor of otolaryngology and pathology and laboratory medicine at the Keck School, on lab research.

In addition, they are working with Brenda Villegas, speech pathologist in the Department of Otolaryngology/ Head and Neck Surgery, as well as epidemiologist Lihua Liu, researcher in the Department of Preventive Medicine.

“Head and neck cancer is the sixth most common cancer worldwide. Surgical and other treatments are improving the quality of life for patients, but survival rates aren’t improving. In fact, they haven’t changed much in 20 years,” Sinha said.

That is why the researchers are studying what pushes the cancer to spread to the lymphatic system, an event that worsens the prognosis for patients.

Squamous cell carcinomas, which comprise most of the cancers of the head and neck, typically arise as one primary tumor that grows and later metastasizes to the lymph nodes of the neck. But some head and neck cancers metastasize early in their growth, when they appear small—while other head and neck cancers can grow large and are slower to spread.

And unlike in many other cancers, the tumor’s grade—that is, how abnormal the cancer cells appear —also appears unrelated to whether and when a head and neck tumor metastasizes, Masood said. That got the researchers thinking.

Masood and Sinha believe that the genetic characteristics of the tumor—rather than tumor size or the abnormality of the cancerous cells—play a major part in the cancer’s metastasis to the lymph nodes. They are conducting research to try to confirm their beliefs.

The duo want to determine whether expression of any of the genes is linked to cancer spread to the lymph nodes, and whether enzymes may help or hinder the products of the genes, too.

Ultimately, if the researchers can figure out the genetic key players in cancer spread, they may develop therapies against them. They may also be able to use the genes as markers to detect the spread of head and neck cancer earlier—and treat it more successfully.

So the researchers are studying genes that are linked to aggressiveness. If they can identify the genes, and then inhibit them, they may be able to deter high-risk cancers from returning.

The researchers also team with fellow scientists and health professionals on studies that aim to improve the quality of life of cancer patients.

Most patients with high-risk or advanced cancer receive radiation in addition to surgery, but the radiation damages the salivary glands and tissues that enable patients to swallow, speak or even breathe. The researchers are conducting a study to see if inhibiting the function of a key gene can make head and neck cancer cells more vulnerable to radiation, which would allow them to use lower doses of radiation in therapy, reducing side effects.

In another quality-of-life study, the researchers are evaluating a product called VitalStim, which uses electrodes to stimulate the swallowing muscles of the neck and base of the tongue. The patient places the device against the skin, and electrical signals help contract muscles. The researchers hope the stimulation will improve swallowing.

Because radiation hurts the healthy functioning of the muscle tissue, the researchers believe that priming musculature using VitalStim before radiotherapy—and maintaining the muscle with VitalStim during radiotherapy—can help protect swallowing function. Villegas, a speech pathologist in the Department of Otolaryngology/Head and Neck Surgery, administers the VitalStim therapy at USC, the only site in the nation evaluating the therapy for head and neck cancer patients.

Finally, Liu is working with Sinha to study patients’ quality of life after tongue cancer treatment.

Liu’s research is supported by the National Cancer Institute, while the other projects are being funded through the university, as well as private donations. The Chattanooga Group, a private funder, supports the evaluation of the electrical stimulation product.

Keck School researchers seek to improve outcomes for head and neck cancers

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