Stories of ICRF: Dr. Ari Rosenberg

Dr. Ari Rosenberg is an Assistant Professor of Medicine and Medical Oncologist at the University of Chicago. He also serves on the Chicago ICRF Medical Advisory Panel, providing strategic input into furthering the mission of ICRF.

As April is Head and Neck Cancer Awareness month, can you share with our readers some important information about this disease?

When we refer to head and neck cancer, this generally refers to the group of cancers that arises in the subsites of the head and neck such as the mouth, throat, nose, voice box, or even the sinuses or salivary glands. The vast majority (around 90 percent) of cases are squamous cell carcinoma, while the other 10 percent are other rare subtypes such as salivary gland cancers or others. Head and neck cancer represents approximately 3-5 percent of all cancer types, and globally accounts for around 900,000 new cases and approximately 400,000 deaths annually. Males are more commonly affected than women, and are diagnosed more often with advanced age. Risk factors associated with head and neck cancer include smoking and alcohol consumption, and viral infections such as human papillomavirus (HPV) infection. In fact, the rate of new cases for HPV associated head and neck cancers is rapidly increasing, and anticipated to rapidly increase in the future . HPV vaccines can prevent HPV-related cancers and patients should discuss this with their doctors. Some types of cancer that arise from the passages behind the nose can even be associated with a virus called Epstein-Barr Virus (EBV), which is particularly common in East Asia. The initial symptoms of head and neck cancer can vary widely depending on the location of the disease, however some of the more common symptoms include mouth/tongue pain, non-healing ulcers, hoarseness, difficulty swallowing, or even congestion. Often the duration of symptoms is important, particularly when the symptoms don’t improve with time.

Diagnosis of head and neck cancer is generally made with a biopsy, which is a procedure in which a needle is used to take a small sample of the tumor, to be evaluated by an expert pathologist. Once a diagnosis is made, patients are typically evaluated by an otolaryngologist who evaluates the extent of disease and performs an in-depth examination. For more advanced disease, imaging studies such as CT, MRI, or PET scans are utilized to determine the extent of disease. Treatment approaches for head and neck cancer are highly individualized and depend on the type, location, extent of spread, and patient-specific factors to determine the optimal treatment plan. At our institution, patients are evaluated by a multidisciplinary team including a head and neck surgeon, radiation oncologist, and medical oncologists to determine the optimal treatment approach, with the goal of not only treating the cancer, but also to maintain long-term function and quality of life. There are a number of new tests and treatment approaches that are promising to improve survival and quality of life among head and neck cancer patients, and we often discuss clinical trials with patients to evaluate these new treatment approaches to improve outcomes for head and neck cancer patients.

What drew you to this area of oncology?

I was initially drawn to oncology during medical school at the American Student Program at Tel Aviv University. From our classroom to the initial clinical exposure, I was fascinated by the changes that occur in the transition of a normal cell to a cancer cell. The complexity of the genetic and molecular changes that drive a cancer cell to grow in an uncontrolled manner, and the way in which the cancer cell interacts with its surrounding, is an insidious process that causes a great deal of mortality. I was fascinated by the way in which understanding these complex cellular processes not only drive cancer growth, but also the way in which cancer researchers attempt to identify compounds that can target these processes to selectively eliminate cancer cells while preserving normal cells. Even beyond Tel Aviv University to my medicine and oncology training, wonderful mentors along the way provided guidance and role modeling that led me focus on head and neck cancer.

Unfortunately head and neck cancer is a particular challenge given the complexity of the head and neck anatomy. At the same time, this complexity requires a team-based approach to treatment that incorporates multiple specialties including not only surgeons, radiation oncologists, and medical oncologists like myself, but also radiologists, pathologists, speech therapists, nutritionists, dentists, oral surgeons, physical therapists, domain-specific nurses, and many others that are part of the “team.” Working as a team with wonderful colleagues to optimize patient outcomes is an aspect to my work that I very much enjoy. Furthermore, the emergence of immunotherapy, targeted therapies, and other new medications to treat head and neck cancer have changed and are continuing to change the outcome for these patients. It is truly exciting to be a part of emerging therapies in this field.

Can you talk about your connection with ICRF?

I learned about the Israel Cancer Research Fund when I moved from Israel to Chicago after medical school for residency. I had been exposed first hand to not only the excellent clinical skills of oncologists in Israel, but also to the deep and extensive scientific contributions from the field of oncology. The work and discoveries of Israeli scientists are constantly being highlighted to help develop new and improved diagnostic tests, genomic and molecular profiling tools, and novel cancer therapeutics. Our scientific oncology meetings are filled with new basic, translational, and clinical data coming from Israel that inform the cancer field broadly and head and neck cancer specifically. I think ICRF does critical work in supporting these endeavors, which ultimately lead to downstream benefits for patients in the clinic.