Treatment of Laryngeal Cancer in Germany
Best hospitals and doctors for laryngeal cancer treatment in Germany
Leading hospitals
Cost for treatment
Laryngeal cancer is one of the most common malignant tumors of the head and neck area. Most often, it develops due to smoking or the human papillomavirus infection. For the treatment of laryngeal cancer in Germany, doctors use endoscopic procedures, surgical operations, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. After removing the larynx, doctors restore speech function with voice prosthesis implantation.
Content
- Endoscopic treatment
- Surgical treatment
- Voice function restoration
- Radiation therapy
- Drug therapy
- Why is it worth undergoing treatment in Germany?
Laryngeal cancer is development of the malignant neoplasm from the tissues of the larynx. Treatment options in Germany include surgery, radiation therapy, systemic and local chemotherapy, immunotherapy, and targeted therapy.
These are partial and total laryngectomy, laryngopharyngectomy, and neck dissection. Laser surgery can be used in early cancer stages.
The voice function is restored with the help of a voice prosthesis. This is a device, valve, that make sounds instead of the removed vocal cords.
Radiation therapy can be the only treatment for early-stage laryngeal cancer, complement surgery or be combined with chemotherapy.
Treatment of laryngeal cancer in Germany with Booking Health includes sparing and unique surgeries, access to novel drugs and advanced equipment. The average price of the laser tumor resection is 21,200 EUR, the minimum price is 16,700 EUR, and the maximum price is 28,500 EUR.
Endoscopic treatment
Endoscopic surgery is rarely performed. It can only be an option at a very early stage of the disease, and most tumors do not cause symptoms when they are small. The exception is neoplasms in the area of the vocal cords. They cause a change in voice timbre, even at an early stage. These tumors are more favorable in terms of prognosis, they metastasize less often and recur less often after surgery.
An endoscopic procedure implies tumor removal with a mechanical instrument or a laser. The instruments are inserted through the mouth, so no skin incisions are required. The doctor controls his actions with the help of a mini video camera with lighting. Only part of the mucous membrane in the area of the vocal cords is removed, so patients do not lose their speech function. In Germany, neoplasms at the early stages are often removed with a laser, as this procedure is more sparing and safe.
Surgical treatment
Laryngectomy is the main treatment for laryngeal cancer. The doctor removes the larynx totally or partially.
Partial laryngectomy involves the removal of part of the larynx. There are different method options for a partial laryngectomy, which depend on where the tumor is located and at what stage the disease is detected. In any case, the goal of organ-sparing treatment for laryngeal cancer is to remove the tumor totally, whilst preserving as much organ tissue as possible.
Supraglottic laryngectomy is the removal of part of the larynx above the vocal cords. It is performed on tumors that develop in the epiglottis. After this surgical intervention, the patient’s speech function is preserved.
Hemilaryngectomy involves the removal of the right or left side of the larynx. The patient retains one vocal cord, so their speech function is partially preserved.
Total laryngectomy is an operation to remove the entire larynx. After this surgical procedure, a person can breathe through a tracheostomy: an opening in the front of the neck. The speech function is completely lost. However, it can be restored in various ways: a laryngeal prosthesis, an electrolarynx, or learning esophageal speech (ventriloquism). This operation does not cause a swallowing function impairment, since the pharynx and esophagus are not damaged.
Pharyngectomy is an operation to remove the pharynx. With locally advanced tumors, this stage of the operation may be required in addition to a laryngectomy. After tumor removal, the patient needs a reconstructive phase of the operation to restore the ability to swallow.
Cervical lymph node dissection is usually performed simultaneously with surgery to remove the tumor. Lymph node dissection is required, regardless of whether there are clinical signs of metastasis to the lymph nodes of the neck. This procedure allows the doctors to examine the nodes, check them for metastases, and accurately determine the stage of the disease. In turn, the stage determines what kind of cancer treatment you will be prescribed after the operation. Cervical lymph node dissection is performed in different scopes, depending on the characteristics, location of the primary tumor, and the presence of any clinical signs of metastasis spreading to the lymph nodes. The more lymph nodes removed, the lower the risk of cancer recurrence, but, the higher the likelihood of complications. In addition, during more radical operations, not only the structures of the lymphatic collector are damaged, but also the nerves, muscles, and veins.
Thyroidectomy is the removal of the thyroid gland. This stage of the operation is required for patients with cancer that has spread to the corresponding organ. The doctor can remove only one lobe (half) of the thyroid gland, or the entire organ. After total removal, the patient will need lifelong replacement therapy with thyroxine, the main thyroid hormone that is no longer produced after surgery.
Reconstructive surgery can be performed simultaneously, immediately after a tumor removal, or at the second stage of treatment. The doctor's task is to restore the structure and function of the removed organs and tissues. To reconstruct the throat, muscles from the thorax are used. Sometimes the material is taken from the patient’s intestines or the muscles of their arm. Free graft transplantation has become possible due to the development of microsurgical techniques. Now, doctors can suture all the vessels together to restore a normal blood supply to the autograft and avoid its necrosis.
Voice function restoration
Three methods can be used to restore speech:
Learning esophageal speech is the easiest but least effective way. The patient is taught ventriloquism. He swallows air and then uses it to produce speech. However, the volume of air is small, so the speech is quiet and intermittent.
Electrolarynx is a rehabilitation method that has been used since the 1920s. However, over the past 100 years, it has become outdated. No more than 10% of those operated on for laryngeal cancer use an electrolarynx. The voice is monotonous and quiet, with a metallic timbre.
Tracheoesophageal shunting and voice prosthesis placement is the main method of rehabilitation in Germany. This is the most effective option for restoring speech. A canal is formed between the esophagus and trachea. Then, air enters from the respiratory tract into the esophagus, inside which, the laryngeal prosthesis is located. It consists of silicone and contains a protective valve that prevents the entering of food from the esophagus into the respiratory tract. Depending on the quality of the prosthesis, it has to be changed once every few months, or every few years.
Radiation therapy
Radiation therapy for the treatment of patients with laryngeal cancer can be used in the following cases:
- Self-treatment for cancer in the early stages allows the patient to avoid surgery and provides better preservation of speech function.
- Any stage of cancer, if there are medical contraindications for surgery. Radiation therapy is used as an alternative treatment method, and can be carried out according to a radical program. Doctors aim to destroy the tumor completely using high doses of radiation. Radiation therapy can cure cancer, but it is less likely to than surgery.
- After surgery – to reduce the risk of cancer recurrence.
- To suppress recurrent tumors.
- In the advanced stage of the disease – to relieve cancer symptoms, eliminate bleeding, reduce tumor foci in the bones and lungs.
Radiation therapy is often combined with chemotherapy. The two methods are applied simultaneously. Together they work better, and they are more likely to cure cancer, provide a longer recurrence-free period, and give better survival rates when compared to their sequential use. However, such treatment is more toxic. Therefore, it is used if the patient's health condition allows for chemoradiotherapy.
Radiation therapy weakens the immune system in the affected area. Therefore, prior to treatment, it is worth seeing a dentist to make sure that the health of the dentoalveolar system is in good condition. If there are chronic foci of infection, they need to be eliminated.
Types of radiotherapy for laryngeal cancer:
- external beam radiation therapy is used in most patients, the radiation source is outside the human body;
- brachytherapy is a contact irradiation with radioactive seeds.
Brachytherapy is used less frequently. It is used only in specialized centers. This treatment is invasive, as it requires the placement of radioactive material inside the larynx. However, it has the advantage of having less health risks, since the radiation does not affect healthy tissue on its way to the tumor and does not damage it. Brachytherapy is used to treat cancer in its early stages, as well as to suppress recurrent tumors.
Most patients in Germany receive treatment with external beam radiation therapy. In the standard version, it is held 5 days a week, for 7 weeks. Some German hospitals perform accelerated irradiation programs: the radiation dose is increased, but the course can be completed in 5-6 weeks.
There are different options for external beam radiation therapy. Doctors in Germany use IMRT for laryngeal cancer. This is a very precise, health-friendly option of radiation therapy and allows radiation to be delivered to the target very precisely, from different angles, to minimize the damage to healthy tissue. Tumor sites near the vital organs receive less radiation to reduce the risk of post-radiation complications.
Drug therapy
The following methods of drug therapy are used in Germany for the treatment of cancer:
- chemotherapy;
- targeted therapy;
- immunotherapy.
Chemotherapy can be used in the following cases:
- As the main treatment for patients with laryngeal cancer, if surgery is not possible. Chemotherapy is usually combined with radiation therapy as part of chemoradiotherapy.
- After the operation. Chemotherapy is combined with radiation therapy or, chemotherapy alone is used if the patient's health condition does not allow for both types of treatment at once.
- Before the operation. This type of chemotherapy is called neoadjuvant chemotherapy. Doctors try to shrink the tumor so that it can be removed. In some patients, after induction chemotherapy, the tumor disappears completely. Radiation therapy is then performed instead of surgery.
- Inoperable tumors. Chemotherapy is used to relieve symptoms and increase the life expectancy of patients.
Hospitals in Germany conduct targeted therapy with EGFR inhibitors. These are monoclonal antibodies that target the epidermal growth factor. They block proteins that help tumors grow faster. They are used in the advanced stages of laryngeal cancer. It is possible to use EGFR inhibitors alone with radiation therapy if chemotherapy is contraindicated. In addition, targeted therapy and chemotherapy are used simultaneously for the treatment of the metastatic form of the disease.
PD-1 inhibitors (immune checkpoint inhibitors) are used for immunotherapy of laryngeal cancer in Germany. They are prescribed as first-line therapy in a case of detection of distant metastases and in recurrent tumors. These drugs do not have a cytotoxic effect, but work solely by enhancing antitumor immunity. They prevent tumors from hiding from immune cells.
Why is it worth undergoing treatment in Germany?
There are a few reasons why it is better for you to undergo treatment of laryngeal cancer in Germany:
- cancers in the early stages are cured with endoscopic procedures: without incisions on the neck, from inside the larynx, whilst maintaining speech function;
- preference is given to organ-preserving operations, with the preservation of part of the larynx, if possible;
- surgical removal of the neck lymph nodes can be performed endoscopically: through short incisions to reduce the trauma rate of the intervention and improve the aesthetic result;
- after the removal of the neck tissues, they are reconstructed with the patient's own tissues;
- in a case of the removal of part of the pharynx, a reconstructive stage of the operation is performed to fully restore the function of swallowing, so that you do not have to eat through a tube in your stomach;
- after total removal of the larynx, a tracheoesophageal bypass is performed, with the implantation of a voice prosthesis, which will allow the patient to have fully restored speech;
- the use of high-quality prostheses that do not need to be changed every few months, since they serve for several years, do not displace, and do not enter the respiratory tract;
- the use of the very latest irradiation options, which are very accurate and safe for health;
- the use of modern drug therapy regimens, with medications for targeted therapy and immunotherapy.
To undergo laryngeal 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. Average prices for some of the therapeutic options are as follows:
- Treatment of laryngeal cancer with laser resection – 21,400 EUR
- Treatment of laryngeal cancer with extensive resection and tracheostomy – 23,600 EUR
- Treatment of laryngeal cancer with radiotherapy – 20,550 EUR
The average price of rehabilitation after laryngeal cancer treatment in Germany is 1,190 EUR per day, the minimum price is 1,041 EUR per day, and the maximum price is 1,553 EUR per day.
You are welcome to leave your request on the website of the medical tourism operator, Booking Health. Our employee will contact you, consult with you, and answer all of 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 the treatment of laryngeal cancer and achieve the best results.
- We will help you to overcome the language barrier and establish your communication with the doctor and medical staff 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 medical tourists.
- 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 medical 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 required.
- 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. Farrukh Ahmed. 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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