head-and-neck

Adenoid cystic carcinoma is a slow but relentless cancer of the salivary glands that creeps along nerves and comes back years later, often in the lungs. Surgery with radiotherapy is the only cure, chemotherapy barely works, and the tablets lenvatinib and axitinib can hold spreading disease still for months rather than shrink it.

Canadian surgeon who led ORATOR, the first randomised trial to compare robotic surgery with radiotherapy for early throat cancer, which found swallowing was slightly better after radiotherapy.

Led KEYNOTE-048, which made pembrolizumab first-line therapy for recurrent or metastatic head and neck cancer.

Cancer of the cheek lining and gums is India's commonest cancer in men, caused by chewing tobacco and areca nut. Surgery with reconstruction is the mainstay, and trials from Tata Memorial in Mumbai have shown that removing the neck nodes up front, cheap oral chemotherapy, tiny doses of immunotherapy and visual screening by health workers all save lives at low cost.

Melbourne oncologist who led C-POST, the trial that showed cemiplimab after surgery and radiotherapy cuts recurrence in high-risk cutaneous squamous-cell carcinoma.

Esthesioneuroblastoma is a rare cancer of the nasal cavity and sinuses that arises from the smell-sensing olfactory nerve lining at the roof of the nose, next to the brain. It is treated with surgery through the nose or skull base followed by radiotherapy, with chemotherapy added for high-grade or widespread tumours, and because it can return a decade or more later patients are followed for life.

Led KEYNOTE-040, which showed pembrolizumab improves survival in previously treated head and neck cancer.

Surgeon who led De-ESCALaTE and PET-NECK, two trials that changed how HPV-positive throat cancer is treated and followed up.

Head and neck cancers caused by tobacco and alcohol rather than HPV are harder to cure: surgery or cisplatin chemoradiation is the mainstay, immunotherapy given around surgery (KEYNOTE-689) or after it (NIVOPOSTOP) has begun to help, and pembrolizumab is the first treatment once the disease has spread.

Throat cancers caused by HPV are usually cured with chemoradiation or robotic surgery, so trials now ask how much treatment can be taken away: swapping cisplatin for cetuximab failed, cutting the radiation dose has worked only after surgery so far, and blood tests for HPV DNA may pick out the patients who can safely have less.

Cancer of the hypopharynx, the funnel behind the voice box, is the head and neck cancer with the worst outlook because it grows silently and spreads to the neck early. Treatment is chemoradiation to keep the larynx where possible, or removal of the larynx and pharynx with reconstruction for the most extensive tumours.

Led EXTREME and TAX 323, which defined the chemotherapy standards for head and neck cancer for a decade.

Radiation oncologist behind the MACH-NC meta-analyses that proved chemoradiotherapy helps head and neck cancer, and the first FLASH-treated patient.

Brussels oncologist who led KEYNOTE-412, the trial that tested adding pembrolizumab to chemoradiotherapy for locally advanced head and neck cancer.

Nice oncologist who led TPExtreme, the GORTEC trial that showed the shorter TPEx regimen is a reasonable alternative to EXTREME for recurrent or metastatic head and neck cancer.

Cancer of the lip is really a skin cancer of the sun-exposed lower lip, usually found early because it can be seen. A small operation or radiotherapy cures most people, and reconstruction keeps the mouth working.

Locoregionally advanced nasopharyngeal carcinoma is nasopharyngeal cancer, the Epstein-Barr-virus-driven cancer behind the nose, that has grown into nearby structures or neck lymph nodes but not further. It is treated without surgery, by precise radiotherapy with cisplatin, usually after gemcitabine and cisplatin chemotherapy and in recent trials with PD-1 immunotherapy; most patients are cured.

Established that HPV causes a distinct, better-prognosis form of throat cancer and led RTOG 1016 on how to treat it.

Mucoepidermoid carcinoma is the most common salivary gland cancer and, for most people, one of the most curable: low-grade tumours are removed surgically and rarely return, while high-grade tumours need radiotherapy after surgery and are treated like other aggressive head and neck cancers if they spread.

Cancers of the nose and sinuses are a mixed group, from squamous carcinoma to the nerve-derived esthesioneuroblastoma and the aggressive undifferentiated carcinoma SNUC. Surgery through the nose with an endoscope followed by precise radiotherapy has replaced disfiguring open operations, and giving chemotherapy first to see who responds now guides how SNUC is treated.

A cancer at the back of the nose caused largely by the Epstein-Barr virus and common in southern China and Southeast Asia. Radiation cures most early cases; adding chemotherapy and, recently, PD-1 immunotherapy has improved outcomes in advanced disease, and a blood test for viral DNA can detect it early.

NUT carcinoma is a fast-growing cancer of the midline of the body driven by a single fused gene, BRD4-NUTM1, that locks cells in an immature state. Chemotherapy and surgery rarely control it for long, but drugs that block the BET proteins the fusion depends on have produced responses and are the focus of trials.

Cancer of the front of the tongue or the floor of the mouth is treated first with surgery, and a Tata Memorial trial settled that the neck lymph nodes should be removed at the same operation even when scans look clear. How deep the tumour has grown is now the number that decides staging and the need to treat the neck.

Chairs NRG Oncology, the largest US radiotherapy cooperative group, and leads head and neck de-escalation trials.

Surgeon-scientist who led the first neoadjuvant pembrolizumab trial in head and neck cancer and the KEYNOTE-689 study that made it standard.

Recurrent or metastatic nasopharyngeal carcinoma is nasopharyngeal cancer that has come back after radiotherapy or spread to the bones, liver or lungs. Gemcitabine with cisplatin is the chemotherapy backbone, adding a PD-1 antibody such as toripalimab in JUPITER-02 and later trials lengthened survival and became standard, and local recurrence is treated with endoscopic surgery or re-irradiation.

When head and neck cancer comes back where it cannot be removed, or spreads elsewhere, it is treated to extend life rather than cure: pembrolizumab, alone or with chemotherapy, is the first choice, cetuximab-based regimens and cheap oral chemotherapy are alternatives, and antibodies that hit two targets at once are in late-stage trials.

Surgeon and immunologist who led CheckMate 141, the trial that made nivolumab the first drug to lengthen survival in head and neck cancer after platinum failure, and E3311 on transoral surgery for HPV-positive throat cancer.

Salivary duct carcinoma is an aggressive cancer of the parotid gland that behaves like a high-grade breast cancer and carries the same switches: most tumours run on the androgen receptor and about a third on HER2, so hormone blockers borrowed from prostate cancer and trastuzumab borrowed from breast cancer now shrink many of them.

Salivary gland cancers are a family of over 20 rare cancers, each with its own behaviour and often its own gene fusion. Surgery and radiation treat most; drug therapy is now chosen by the specific subtype, from anti-HER2 or anti-androgen drugs to NTRK inhibitors.

Sinonasal undifferentiated carcinoma is a rare, fast-growing cancer of the nasal cavity and sinuses made of primitive cells with no clear line of differentiation, most carrying an IDH2 mutation. It presents as a large mass pressing on the eye or brain and is treated with chemotherapy first, then surgery or chemoradiotherapy depending on response; SMARCB1- or SMARCA4-deficient tumours are separate.