Ear Cancer. Treatment in Germany
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Ear cancer includes many different histological types of malignant tumors that develop on the auricle, in the external ear canal, or in the middle ear. These tumors spread rapidly to the temporal bone and other nearby structures. Their removal requires technically complex surgical interventions. German doctors successfully cope with ear cancer treatment even at stages 3-4, providing a complete cure for the disease or increasing a patient’s life expectancy by several years. Radiation therapy is used both after surgery, and as an independent treatment method. It is often used simultaneously with chemotherapy.
Content
- What is ear cancer?
- Diagnostics
- Principles of treatment
- Surgical treatment
- Radiation therapy
- Drug therapy
- Why is it worth undergoing ear cancer treatment in Germany?
What is ear cancer?
Ear cancer is a rare disease, accounting for 0.2% of all head and neck neoplasms. Even in large countries, only a few hundred such cases are recorded per year.
The tumors develop in the following sites:
- auricle – 70% of cases;
- external ear canal – 20% of cases;
- middle ear – 10% of cases.
According to its morphological structure, ear cancer has the following types:
- squamous and basal cell carcinomas account for 61% of cases (skin cancer);
- glandular cancer accounts for 38% of cases;
- melanomas and sarcomas account for 1% of cases.
The most common type of cancer in the external ear canal is squamous cell carcinoma. Basalioma occurs 2-3 times less frequently.
Neoplasms in patients with outer ear cancer behave aggressively, quickly spreading to the parotid gland, temporomandibular joint, mastoid bone, skull bones, and meninges. Ear cancer treatment is complex, since in 30% of cases, the disease is detected at stage 3, and in 40% of cases, at stage 4.
Staging of ear cancer according to the classification of the University of Pittsburgh:
- stage 1 – tumor within the external ear canal;
- stage 2 – development of bone erosion or soft tissue infiltration up to 0.5 cm;
- stage 3 – penetration into the middle ear, soft tissue infiltration of more than 0.5 cm, destruction of the bone walls of the external ear canal, or spread to the cells of the mastoid process;
- stage 4 – destruction of the cochlea, petrous apex, the inner wall of the middle ear, invasion into the carotid artery canal and the jugular foramen, facial nerve lesions.
Middle ear cancer is a rare tumor that accounts for about 10% of all neoplasms of this organ. The disease is diagnosed late. As a rule, patients unsuccessfully try to be treated for chronic otitis media for a long time. The main morphological form is squamous cell carcinoma. Glandular tumors are much less common.
Diagnostics
The auricle can be examined by both the patient and the doctor. Therefore, tumors of this localization are detected much earlier, usually at stages 1-2. The first sign and reason for going to the doctor is the appearance of a volumetric formation, ulceration, or redness on the ear. The diagnosis is then confirmed with a biopsy.
External ear canal tumors and middle ear tumors cannot be seen with direct examination, so they develop imperceptibly for several months. Then, the symptoms manifest themselves. The most common reason for seeking treatment is pain. Other symptoms include itching, purulent discharge, and bleeding. When the tumor reaches a large size, it compresses the ear canal and impairs the patient's hearing.
When palpating, the physician determines soreness and swollen tissue. The regional lymph nodes may be enlarged as well.
External ear canal tumors can be detected with an otoscopy. The doctor examines the neoplasm under magnification. The diagnosis is confirmed with a biopsy.
Computed tomography is used to clarify the diagnosis, assess the stage of the disease, and select the preferred surgical treatment option. Magnetic resonance imaging is less commonly used.
Principles of treatment
The preferred treatment method is surgery. This is the only technique that can provide a total cure for ear cancer. Even in the advanced stages, when the disease is incurable, the operation allows the doctors to achieve the greatest increase in human life expectancy.
When performing the operation, doctors have to perform a partial or total removal of the temporal bone, as well as the lymph nodes and some soft tissues. After surgery, radiation therapy may be required, often in combination with chemotherapy.
Even if doctors believe that they are unlikely to be able to remove the tumor totally, the operation is still performed. The residual tumor is suppressed by radiation.
A small number of patients with the advanced disease are not considered candidates for surgical treatment. The reason for the refusal of the operation may also be medical contraindications. In such cases, radiation therapy becomes the main treatment, often in combination with chemotherapy. The role of targeted therapy and immunotherapy have not been defined, but these techniques are used in some hospitals.
External ear cancer responds to treatment better than middle ear tumors. The five-year survival rate of patients with ear canal tumors, even at stages 3-4, is 40-60%, while the indications for middle ear neoplasms are worse, 15-20%. In the early stages of ear cancer, about 80-85% of patients can be completely cured.
Surgical treatment
The type of surgery performed depends on where the tumor appeared and how early it was detected.
In the early stages, either radiation therapy or surgery to remove the auricle is performed.
The treatment is more complex for patients with locally advanced neoplasms.This includes major surgery with the resection of the petrous part of the temporal bone.
Historically, the first surgical treatment for cancer that had spread to the temporal bone, was a mastoidectomy (mastoid process removal). The five-year survival rate after this intervention was 17%.
In 1954, an alternative appeared: a subtotal temporal bone resection, and in 1960 a lateral resection was developed, which is still used today. This classical operation involves the removal of the external ear canal, tympanic membrane, and auditory ossicles, with the separation of the Incudostapedial joint. Doctors isolate the facial nerve and remove the parotid salivary gland.
Total resection of the petrous part of the temporal bone is the most aggressive surgical option, in which, doctors totally remove it, often without preserving the internal carotid artery. This surgery was first performed in 1984. The development of all these operations at the end of the twentieth century increased the five-year survival rate of patients to 30%.
A more sparing operation was proposed in 1997: an extended temporal bone resection with the preservation of the internal carotid artery, and partial removal of the petrous apex. It has demonstrated a high efficiency: the five-year survival rate has reached 47% even in an advanced stage of cancer, but with radical (total) tumor removal. The results are even better with a combination of surgery and irradiation: the five-year survival rate of patients reaches 63%.
Currently, there are no standard treatment methods, as ear tumors are rare. Some doctors prefer aggressive surgical tactics. Others prefer sparing operations with the preservation of functionally important structure, and the follow-up destruction of tumor remnants with the help of radiation therapy.
Radiation therapy
Radiation therapy was historically the first treatment for locally advanced ear cancer. However, in an independent review, it turned out to be ineffective: in 80% of cases, ear canal tumors recurred during the first year.
Since the 1980s, irradiation has been used as an addition to surgery. The tumor was first removed and then irradiated, to reduce the risk of recurrence. However, preoperative radiation is used very rarely. This is due to the fact that many ear neoplasms progress due to a purulent inflammatory process. As a result, preoperative irradiation causes complications: radiation osteonecrosis, and meningitis (inflammation of the meninges).
As of today, radiation therapy is mainly used in the following cases:
- for the treatment of early cancer – alone or in combination with surgery;
- after the surgical removal of a locally advanced tumor, to reduce the risk of recurrence;
- as an independent treatment method for stages 3-4 of the disease.
Doctors may consider the surgery inappropriate in the following cases:
- extensive tumor involvement of the dura mater;
- involvement of the temporal lobe of the brain;
- invasion in the posterior cranial fossa;
- sigmoid sinus lesions.
If surgery is not performed, radiation therapy or chemoradiotherapy becomes the main treatment option. A combination of radiation therapy and chemotherapy is more effective. According to a Japanese study, this provides a five-year survival rate in 67% of cases, even at stage 4 of the cancer.
New types of radiation therapy are being used in Germany. The ear canal tumors and middle ear tumors are located close to important anatomical structures, including large nerves and blood vessels. Therefore, it is very important to direct the radiation as accurately as possible, so as not to damage healthy tissues and not cause post-radiation complications.
Doctors in developed countries use IMRT (intensity-modulated radiation therapy) for ear canal. The beams are directed from different angels and converge on the tumor to minimize the damage to healthy tissue. The sites near the anatomically important structures are irradiated with lower doses of radiation to avoid side effects.
Several German hospitals, including the University Hospital Heidelberg and the University Hospital Essen, offer proton therapy. Head and neck cancer is one of the main diseases suitable for this type of therapy. Protons, unlike photons, emit radiation only upon reaching their target, not along the entire trajectory of their movement through healthy tissues. Therefore, the technique is even safer. In addition, this therapy allows the specialists to deliver higher doses of radiation to the tumor, getting better treatment results.
Drug therapy
Germany uses the very latest medicines for cancer. This is not only chemotherapy, but also targeted therapy, immunotherapy, etc.
Drug therapy for cancer can be used in the following cases:
- after surgery, to reduce the risk of cancer recurrence;
- simultaneously with radiation therapy as the main treatment option for locally advanced cancer (if the patient is not considered a candidate for surgery);
- as the main treatment method for advanced and recurrent tumors.
Why is it worth undergoing ear cancer treatment in Germany?
Ear cancer is a rare tumor, and not all doctors have experience in its treatment. There are specialized centers in Germany where surgeons regularly perform surgery for patients with this disease. They successfully perform the most complex operations for the resection of the temporal bone and surrounding structures involved in the tumor process. Surgery is successfully combined with radiation therapy and chemotherapy. Doctors achieve good results even at stages 3-4 of cancer.
Here are a few reasons for you to go to Germany:
- modern safe operations;
- comprehensive postoperative care and recovery;
- low risk of complications;
- very latest options of radiation therapy, including proton therapy, which allows the doctors to destroy the tumor with minimal damage to healthy tissue;
- modern drugs are used for drug therapy for cancer.
To undergo ear cancer treatment in Germany, please use the Booking Health service. On our website you have the opportunity to get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals, and book a medical care program at a favorable price. The treatment will be easier and quicker for you, and the cost of treatment in Germany will be lower.
You are welcome to leave your request on the Booking Health website. Our employee will contact you, consult with you, and answer all your questions. We will take care of the organization of your trip abroad. We will provide the following benefits for you:
- We will select the best German hospital, whose doctors specialize in ear cancer treatment and achieve the best results.
- We will help you overcome the language barrier and establish your communication with the doctor at the German hospital.
- We will reduce the waiting period for diagnostics and treatment, and you will receive medical care on the most suitable dates for you.
- We will reduce the price. The cost of treatment in Germany will be lower than usual due to the lack of overpricing and coefficients for foreign patients.
- Our specialists will solve any organizational issues: paperwork, transfers from the airport to the German hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to undergo any previously performed diagnostic procedures.
- We will stay in contact with the German hospital after the completion of your treatment.
- We will organize additional diagnostics and treatment, if necessary.
- We will buy medicines in the other country and forward them to your native country.
While the best specialists in the world take care of your health, the Booking Health staff will help you to reduce the cost of treatment in Germany and take care of all your travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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