Nasopharyngeal Cancer. Treatment in Germany
Best hospitals and doctors for nasopharyngeal cancer treatment in Germany
Leading hospitals
Cost for treatment
Nasopharyngeal cancer is a rare head and neck tumor. Its treatment mostly involves the use of radiation therapy, often in combination with chemotherapy. Less commonly, doctors perform surgery to remove the primary tumor and cervical lymph nodes. In the advanced stages, German doctors resort to chemotherapy, targeted therapy and immunotherapy. You can go to Germany to receive treatment for nasopharyngeal cancer. Most cases of the disease are successfully cured in this country.
Content
- What is nasopharyngeal cancer?
- Principles of treatment
- Radiation therapy
- Chemotherapy
- Targeted therapy and immunotherapy
- Surgical treatment
- Why is it worth undergoing treatment in Germany?
Nasopharyngeal cancer is development of the malignant neoplasm from the mucosal epithelium of the nasopharynx, which is the upper part of the throat. Treatment options in Germany include radiation therapy, immunotherapy and chemotherapy, surgery.
The main principle is suppressing a tumor with chemotherapy or chemoradiotherapy. Surgery is used only to remove lymph nodes or treat recurrent cancer.
Types of radiation therapy used are external-beam radiation therapy, proton therapy, stereotactic radiosurgery, and brachytherapy.
Chemotherapy is the main type of systemic treatment for nasopharyngeal cancer. A combination scheme is typically used.
Treatment of nasopharyngeal cancer in Germany with Booking Health includes access to novel chemotherapy agents and advanced equipment for radiation therapy. The average cost of chemoradiotherapy for nasopharyngeal tumors is 24,900 EUR, the minimum price is 20,800 EUR, and the maximum price is 30,200 EUR.
What is nasopharyngeal cancer?
The pharynx is an organ located in the head and neck. It is part of the digestive system: it is located between the oral cavity and the esophagus. The pharynx consists of three parts: nasal, oral, and laryngeal. They are called the nasopharynx, oropharynx, and laryngopharynx.
The nasopharynx is the upper part of the pharynx. Malignant tumors in this area are called nasopharyngeal cancer. The Epstein-Barr virus and chronic inflammation are considered to be the main causes of this disease. The disease is most common in Southeast Asia, Africa, and Indochina, but it is rare in Western countries. Most clinical cases are squamous cell carcinoma.
The early stages of nasopharyngeal cancer usually proceed under the guise of inflammatory diseases: acute respiratory infections, rhinopharyngitis, and adenoid vegetations. Therefore, most cases of the disease are diagnosed only after the onset of metastases in the regional lymph nodes.
Diagnostic methods for nasopharyngeal cancer include:
- rhinoscopy – anterior and posterior (examination of the nasal cavity);
- nasopharyngoscopy – examination of the nasopharynx, with imprint smears and biopsy specimens to confirm the diagnosis;
- blood PCR to detect Epstein-Barr virus DNA (used to control nasopharyngeal cancer treatment in order to monitor any residual disease after chemoradiotherapy);
- puncture biopsy of the neck lymph nodes with a cytological examination of the material – to detect nasopharyngeal cancer metastases;
- chest CT, as well as CT or MRI of the facial part of the skull (in case of the detection of lymph node metastases);
- MRI to clarify the characteristics of the tumor – an obligatory stage during the planning of radiation therapy.
Principles of treatment
Chemoradiation therapy is the main treatment for nasopharyngeal cancer.
In the early stages, only radiation therapy can be used to reduce the toxicity of the treatment.
Treatment options for locally advanced nasopharyngeal cancer include:
- induction chemotherapy, and then – chemoradiotherapy (simultaneous use of chemotherapy and radiotherapy);
- chemoradiotherapy and then chemotherapy.
The second option is preferable, since it produces higher survival rates for patients with nasopharyngeal cancer.
If nasopharyngeal cancer treatment is successful, the primary tumor and all the lymph nodes will disappear, then, in the future, the patient will only need monitoring. If there are metastases in the lymph nodes, a surgical intervention is required to remove them.
With the development of distant metastases, nasopharyngeal cancer is treated with chemotherapy. But, for cancer treatment in Germany, even at its advanced stage, surgical interventions are sometimes performed. A surgical intervention is possible only in the presence of single metastases, if all of them can be completely removed. In addition, chemoradiotherapy may be used if the doctor believes that all the tumor lesions can be destroyed by radiation.
With local tumor recurrence, chemotherapy is used. Surgical removal of the recurrent tumor or chemoradiotherapy is rarely performed.
Radiation therapy
As a rule, cancer treatment in Germany begins with surgery. However, in the fight against nasopharyngeal cancer, radiotherapy is considered the main method. It is quite effective and often cures the disease completely, and at the same time, is safer for a patient’s health compared to surgery.
The following things are important for the success of radiation therapy:
- accurate determination of the stage of the disease by performing a CT, MRI of the head and neck, chest, as well as lymph node puncture;
- oropharyngeal sanitation (elimination of foci of infection);
- assessment of the condition of the oral cavity, teeth, provision of adequate nutrition.
The scope of the radiotherapy is planned immediately after a diagnosis is established and is not decreased, even with a good response to induction chemotherapy. The exception is situations where it is necessary to irradiate vital anatomical structures. If the tumor foci in these places have disappeared under the influence of chemotherapy, then the dose of radiation can be reduced to make nasopharyngeal cancer treatment safer for a patient’s health.
Preferred radiotherapy options are:
- IMRT;
- VMAT;
- 3D conformal radiotherapy if possible.
In Germany, you will be treated with IMRT (intensity-modulated radiation therapy) or VMAT (volumetric modulated arc therapy). These methods of irradiation are safer for your health. They rarely cause severe post-radiation complications. With the use of new techniques, the tolerability of not only radiotherapy, but also chemoradiotherapy, improves.
Some hospitals use proton therapy. It has a higher safety rate and head and neck tumors are one of the main indications for the use of this technique. Photons are usually used to irradiate neoplasms. They emit radiation not only in the tumor, but during the entire movement towards the target. Protons release most of their energy upon reaching the target, so they do less damage to healthy tissue.
Chemotherapy
Most patients receive chemotherapy for nasopharyngeal cancer. It is used in the following cases:
- induction chemotherapy is conducted to reduce the tumor size before chemoradiotherapy;
- chemotherapy is combined with radiotherapy for nasopharyngeal cancer, within the framework of chemoradiotherapy – this is the main treatment method for the disease;
- adjuvant chemotherapy is conducted after chemoradiotherapy to reduce the risk of recurrence (in patients who did not receive induction chemotherapy before irradiation);
- an independent treatment method, chemotherapy is used in the advanced stage of the disease, in patients with distant metastases.
Targeted therapy and immunotherapy
Targeted therapy uses antibodies to target the epidermal growth factor receptor (EGFR). This protein is located on the surface of cancer cells. It receives signals that cause the cell to constantly divide. By blocking this protein with drugs, doctors thereby slow down the progression of nasopharyngeal cancer.
Targeted therapy drugs are not used as first-line treatment options. They are used in the following cases:
- in cases with insufficient effectiveness of chemotherapy;
- in case of cancer recurrence after a primary treatment;
- in advanced stages of nasopharyngeal cancer.
Targeted therapy drugs are safer and better tolerated compared to cytostatic polychemotherapy. However, they sometimes cause side effects: skin rash, headache, weakness, fever, diarrhea, and nausea. Allergic reactions develop occasionally, but they can be eliminated with anti-inflammatory drugs.
Immunotherapy uses PD-1 inhibitors. They are called immune checkpoint inhibitors. They do not have a direct cytotoxic effect on the tumor, but enhance the response of antitumor immunity. PD-1 inhibitors are relatively safe for health, although they cause autoimmune reactions in some people. It is possible to carry out nasopharyngeal cancer treatment with immunotherapy, even as a first-line therapy, but more often, such treatment is used for recurrences or in the advanced stage of oncology with distant metastases.
Surgical treatment
In oncology, surgical treatment is considered the main treatment. However, in cases of oropharyngeal oncology, surgery is rarely performed, for two reasons:
- radiation therapy also provides good results;
- surgical removal of the primary tumor is technically complex.
Therefore, surgery is mainly used to remove lymph nodes. In progressive hospitals in Germany, these operations can be performed using a minimally invasive, endoscopic technique. Such operations provide a better aesthetic result: since the incisions on the neck are shorter and there are no large scars on the skin.
In specialized, progressive oncology hospitals in Germany, the removal of tumors at an early stage is carried out using an endoscopic technique. The surgical interventions are performed through the nose. The main advantage of surgery over radiotherapy is that doctors receive material for histological examination. They can check the cleanliness of the resection margin to make sure the nasopharyngeal cancer has been totally removed. In a case of incomplete removal, such measures as radiation therapy can be taken to reduce the risk of recurrence.
The surgery is most often performed to remove neck lymph nodes. Neck lymph node dissection can be:
- selective – removal of only the lymph nodes closest to the tumor;
- modified lymph node dissection – removal of nodes on one side of the neck between the lower jaw and collarbone, as well as the resection of muscle and nervous tissue (the brachial plexus is preserved);
- radical lymph node dissection – removal of almost all lymph nodes, and more muscles, nerves and veins.
The more lymph nodes removed, the higher the chances of curing nasopharyngeal cancer. At the same time, more radical interventions increase the risk of complications and side effects. These surgical interventions sometimes cause problems with speech, swallowing, numbness of the ear, impaired mobility of the lower lip, and weakness in the shoulder muscles. Neurological complications resolve after a few months, but if the nerves are intersected or removed, they are permanent.
Why is it worth undergoing treatment in Germany?
Germany offers progressive medicine. The country uses innovative treatment methods for nasopharyngeal cancer. This disease is successfully cured in most patients. German hospitals have state-of-the-art equipment to make treatment more sparing, safer, and less traumatic.
There are a few reasons for you to go to Germany for nasopharyngeal cancer treatment:
- accurate diagnostics allows doctors to establish the spread of the tumor process in order to ideally plan a treatment regimen;
- German hospitals use innovative irradiation methods that deliver radiation precisely to the tumor, with minimal impact on healthy tissues;
- there are several Proton Therapy Centers in the country, where patients can undergo the safest proton irradiation of the tumor;
- specialized hospitals perform minimally invasive, surgical treatment – endoscopic removal of the primary nasopharyngeal tumor;
- cervical lymph node dissection is performed using endoscopic surgery, through short incisions to reduce the trauma of the intervention;
- the use of new regimens of drug therapy for advanced cancer, which include not only chemotherapy, but also targeted therapy and immunotherapy.
To undergo 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. Here you can find average prices for the certain procedures:
- Diagnostic tests for nasopharyngeal cancer – 2,300 EUR
- R0 resection for nasopharyngeal cancer – 17,400 EUR
- Combined chemotherapy and radiotherapy for nasopharyngeal cancer – 22,300 EUR
The average price of rehabilitation after nasopharyngeal 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 Booking Health website. Our employee will contact you within a few hours, 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 nasopharyngeal cancer treatment and achieve the best results.
- We will help you to overcome the language barrier and establish your communication with the doctor of 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. 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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