Treatment of Oropharyngeal Cancer
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Oropharyngeal neoplasms account for 12% of all head and neck tumors. The ratio of male to female patients is five to one. It is due to the lower prevalence of statistical alcoholism among people of the female sex. Most tumors are detected in people after the age of 35. Meanwhile, the incidence of the disease peaks around the age of 60. Despite the statistics, it is essential to know how to identify cancer and treat it after the diagnosis is made.
Content
- How to diagnose oropharyngeal cancer?
- Factors contributing to oropharyngeal cancer development
- Staging of oropharyngeal cancer
- Treatment options for oropharyngeal cancer
- How is surgery carried out in European hospitals?
- Radiation therapy
- Chemotherapy as a part of treatment in Europe
- Prognosis
- Cost of treatment in European hospitals
- How to organize cancer treatment in European hospitals?
How to diagnose oropharyngeal cancer?
Self-assessment is essential when it comes to cancer. It is a first step towards diagnosis making, ensuring that people seek medical help on time.
So, in the initial stage, which lasts up to three months, the neoplasm does not manifest itself. Even if mucosal degeneration occurs, it is rarely noticed by a doctor during a routine examination. This is especially true for masses at the root of the tongue. Symptoms, in this case, are very blurred because cancer grows inward and is not seen or felt on the outside. Formations of the soft palate are the easiest to detect as they tend to form in multiple areas.
In 50% of patients, there are already metastases in the lymph nodes when a tumor is detected. Therefore, patients should be alerted to the appearance of lumps on the neck, even if they are painless. Often this turns out to be the first symptom of cancer. If the lymph node enlargement is visible for a long time and there are no signs of inflammation, then you should see a doctor.
Along with enlarged lymph nodes, the feeling of difficulty swallowing appears, and this is the most common symptom. In a while, it is joined by:
- Painful sensations in the oropharynx
- Hoarseness
- Pain in the ear on the side of the lesion, especially if the pharynx is affected
- Decreased mobility of the tongue
At later stages, the pain becomes intense, and bad breath, blood in the saliva, and coughing up sputum are added to the clinical picture.
During the diagnostic process, an examination with an endoscope is performed. A device allows carrying out the direct examination of the affected area, and the received images can be additionally magnified. A tomography scan is also mandatory to assess the depth of tissue penetration. A biopsy is taken to distinguish the tumor from Vincent's angina or purulent inflammation of the pharynx.
Factors contributing to oropharyngeal cancer development
Medical experts have identified some factors that influence the development of the disease, which include:
- Age. Middle-aged and older people are more susceptible to getting oropharyngeal cancer.
- Gender. Most often, oropharyngeal cancer is diagnosed in male patients.
- Smoking. The vast majority of oropharyngeal cancer patients are smokers. Smokers are more susceptible to the disease than nonsmokers. According to statistics, thirty-five percent of patients who do not give up the harmful habit of smoking after recovery repeatedly suffer from malignant neoplasms in the mouth or larynx. Passive smokers are also at risk for cancer.
- Alcohol. Alcohol abuse increases the risk of getting cancer. About eighty percent of patients consume alcoholic beverages in large quantities. Patients who drink alcohol are six times more susceptible to oropharyngeal cancer than non-drinkers.
- Improper nutrition. Consumption of junk food, an unbalanced diet, and lack of vitamins and microelements lead to suppression of immune functions. As a result, various diseases, including oropharynx cancer, can develop.
- Decreased immunity against the background of taking certain medications (for example, drugs that prevent the rejection of transplanted organs) can facilitate the development of malignant tumors.
Staging of oropharyngeal cancer
The division into four stages is typical for all oropharyngeal tumors.
At the initial stage, the tumor diameter is usually up to 2 centimeters. If the tumor diameter is more than 2 cm, the cancer is classified as stage two. The development of metastases in the lymph nodes or the size of the primary tumor more than 4 centimeters indicates the third stage. And usually, oropharyngeal cancer affects lymph nodes on both sides.
Two main subtypes are distinguished among oropharyngeal tumors, i.e. operable and inoperable ones. The second refers to neoplasms that have invaded tissues deeply, affected lymph nodes, and spread distant metastases.
The course of lymphomas differs from other types of tumors. Here, the first stage includes formations of a few millimeters in size. At the second stage, there is active growth and involvement of lymph nodes. At the third stage, there is invasion of all surrounding tissues and the spread of distant metastases. The last stage is characterized by the destruction and decay of the surrounding tissues.
Treatment options for oropharyngeal cancer
Because of the wide variety of localizations and tumor types, the course of treatment can vary. Usually, if the process is detected at the first two stages, surgery with tumor removal through the mouth combined with radiation therapy is performed. For the changes in the epithelium that have just appeared, one radiation course may be enough in the treatment regimen.
At the second two stages, surgery is usually not performed because of deep tumor invasion. A combined treatment for oropharyngeal cancer is used, which includes chemotherapy and radiation therapy. It is effective in 70% of cases. Surgery is especially not recommended for soft palate tumors, because it leads to severe oropharyngeal dysfunction.
Surgery at advanced stages of oropharyngeal cancer is performed if radiation and chemotherapy do not help. Most operations are carried out not through the oral cavity but by an incision under the lower jaw. The procedure is called a mandibulotomy.
The most challenging treatment situation is when the jawbones are also affected. In this case, doctors have to remove a large volume of tissue, which often causes complications, and requires plastic reconstruction. Severe operations include the removal of the tongue if the neoplasm at the root is not sensitive to radiation therapy.
Additionally, treatment options for oropharyngeal cancer often involve radiation exposure to the lymph nodes to destroy pathological cells inside them.
How is surgery carried out in European hospitals?
Before surgery or any other treatment in Europe, a comprehensive examination is performed. The hematopoietic processes, functioning of the blood clotting system, and the function of the heart, liver, and kidneys are evaluated. A CT is performed before surgery to determine the exact location and size of the tumor. It provides physicians with accurate information about the spread of the process and the degree of damage to bone structures.
The surgeon's primary objective is to remove the tumor and minimize the risk of its recurrence. To do this, they dissect a tumor, stepping back from its edge. At the same time, doctors act as carefully as possible, trying not to affect healthy tissues during surgery. Soft palate, the jawbone, part of the tongue, and regional lymph nodes are removed if necessary. The surgery is carried out by the general and the maxillofacial surgeon. To ensure the complete removal of atypical structures, doctors at European hospitals conduct an urgent pathomorphological study of the removed tissue samples after treatment.
The postoperative recovery includes the early period the first week after intervention for oropharyngeal cancer and the following rehabilitation. At first, a patient stays in a specialized department, under the supervision of medical professionals. This is necessary for early detection of possible complications, which can include bleeding, pain syndrome, or inconsistency of sutures. In addition, the staff carefully monitors the water-electrolyte and acid-base balance parameters, managing them, if necessary.
In a smooth postoperative period, eating is allowed the next day, while a patient is fed through a tube in complicated cases. The diet should be sparing, without spicy food and alcoholic drinks.
Upon discharge, a patient must lead a healthy lifestyle and undergo regular preventive check-ups. It will help avoid unpleasant consequences, such as a recurrence of oropharyngeal cancer and repeated surgery to treat it.
Radiation therapy
For more than seven years, researchers followed patients from medical centers in England, Canada, and Australia who underwent treatment for oropharyngeal cancer. These patients received radiation therapy or underwent transoral robotic surgery.
The clinical trials showed that the two methods had no difference in patient survival rates. Still, at the same time, radiation therapy was more effective in improving swallowing function. Forty percent of patients reported swallowing-related changes after surgery; this required special food preparation. After radiation therapy, only 16% of patients reported such changes.
At the early stages of oropharyngeal cancer, radiation therapy and surgery are very effective. However, the critical aspect is maintaining proper function. In this regard, radiation therapy is preferable.
Types of radiation therapy that are used for oropharyngeal cancer treatment include:
- Distant radiation therapy
- Intensity-modulated radiation therapy (IMRT)
- Brachytherapy
Radiation treatment in Europe minimizes all the risks. Radiation therapy with modulated intensity is often used, where the beams are directed only at the cancerous lesion. The treatment method ensures that surrounding cells and organs receive a minimal dose of radiation. It directs the maximum radiation dose to the tumor and the affected lymph nodes with a minimum affection for the surrounding normal tissues.
Oropharyngeal cancer is radiosensitive. Carrying out both chemotherapy and radiation therapy allows 90% of patients with early stages of the disease and 70% of patients with advanced stages to get cured. The surgical treatment, or biopsy, is also used to verify the diagnosis. Radiation therapy at European hospitals is administered both as an individual measure and in combination with chemotherapy and surgery.
Chemotherapy as a part of treatment in Europe
Chemotherapy for oropharyngeal cancer is a part of the combined treatment for oncopathology. Radiation therapy in combination with cytostatic drugs has traditionally been used as an independent method of curing this malignancy. However, when we talk about ionizing radiation, it has a low selectivity that does not allow the effects of radiation alone to cure cancer. Antitumor drugs are used as adjuvant measures. They influence the cancer cells and regional lymph nodes with metastatic changes, as well as treat distant secondary neoplasms.
All types and regimens of chemotherapy for oropharyngeal cancer are based on the principle of using many groups of cytostatics at the same time. The proven efficacy of individual drugs in monotherapy does not exceed 30-40%. Polychemotherapy (when several groups of chemotherapy drugs are included in the course at once), on the other hand, reduces the risks of developing defense mechanisms in cancer cells and increases the treatment effectiveness. The combined treatment approach increases the five-year recurrence-free survival rate to 30% compared with 21% with radiation therapy alone.
Contraindications to chemotherapy for oropharyngeal cancer include:
- Individual intolerance to drugs
- Low levels of white blood cells and platelets
- Pregnancy and lactation
- Hepatic or renal failure, acute infectious diseases, exhaustion (in such cases, low doses of drugs can be indicated)
Prognosis
Proper treatment of oropharyngeal cancer at its initial stages can save 90% of people. This number is lower for people with disseminated tumors – 45-50%. The best prognosis is for soft palate cancer; even at the third stage, 65% of patients survive.
The worst outcome is cancer of the pharyngeal wall. At stages three, and four, less than 40% of people survive.
The process develops slowly when low malignancy lymphomas are detected, but most patients don’t survive ten years because the tumor is difficult to treat. With high malignancy, the medical picture develops faster. At the first or second stage, 90% of patients can be saved, while 30% of patients can be saved at the fourth stage.
Cost of treatment in European hospitals
The cost of treatment in European hospitals is guided by prices for specific medical care services for oropharyngeal cancer treatment. In general, the cost of treatment depends on the following factors:
- The stage of the disease
- The general condition of the patient
- The anticipated type and duration of treatment
- The experience and level of qualification of the operating physician and the medical staff
- The use of modern equipment that makes treatment more comfortable and safer
The cost of drugs and examinations that may be needed for the oropharyngeal cancer treatment also influences the final cost of treatment. Therefore, the exact price should be checked directly with the doctor who provides medical care or with the clinic's administration.
However, the average price for diagnostics for oropharyngeal cancer amounts to 787 EUR. The cost of treatment with both chemotherapy and radiation therapy is about 20,700 EUR. The price for surgery amounts to 5,518 EUR, and the price for rehabilitation after treatment is around 951 EUR per day.
You can find more information about the cost of treatment in European hospitals on the Booking Health website.
How to organize cancer treatment in European hospitals?
Many people start by searching the web for the oropharyngeal cancer treatment in Europe. Finding a clinic and answering the question of how to come to European hospitals for treatment is a highly responsible process, and patients try to investigate as much information as possible. But it would be best if you trust professionals in the field of medical tourism, with Booking Health being one of the best.
Booking Health provides patients with the highest level of medical care. Professional cooperation with hospitals and specialists allows us to help thousands of patients.
For comprehensive information on treatment in Europe, leave a request on the Booking Health website. Booking Health's medical advisor or a patient case manager will contact you shortly.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. 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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