Treatment of Oropharyngeal Cancer in Germany
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Oropharyngeal cancer is an aggressive tumor characterized by its rapid spread to the head and neck. It often metastasizes to regional lymph nodes and distant organs. You can undergo treatment for this disease in Germany. In this country, you will be treated with sparing laser interventions, new types of radiotherapy, and advanced medications. The Departments of Oncology in Germany provide top-class medical services.
Content
- What is oropharyngeal cancer?
- Principles of treatment
- Surgical treatment
- Radiotherapy
- Drug therapy
- Why is it worth undergoing cancer treatment in Germany?
What is oropharyngeal cancer?
The pharynx is an organ of the neck responsible for the swallowing function. It is located between the oral cavity and the esophagus. The pharynx is divided into three parts: nasal, oral and laryngeal. The oral part is called the oropharynx.
The development of a malignant tumor in this part of the organ is mostly caused by smoking, alcohol, or the human papillomavirus of high oncogenic risk. The HPV status (human papillomavirus infection) is taken into account in staging and influences the cancer treatment regimen.
Most oropharyngeal tumors develop in the tonsils (65% of cases).
The patients with oropharyngeal cancer at the early stages of the disease have the following symptoms:
- swallowing awkwardness;
- persistent sore throat, which is often misdiagnosed as chronic tonsillitis.
When examining patients with cancer of the oropharynx, the doctor sees a tuberous formation, on the surface of which, in most cases, there are ulcers.
As the cancer progresses, it spreads to the retromolar region, the root of the tongue, the soft palate, and the palatine arches. At this stage, patients with oropharyngeal cancer suffer from severe pain that radiates to the ear and head. Patients with headaches usually cannot get rid of their symptoms with nonsteroidal, anti-inflammatory drugs.
With the decay of the oropharyngeal tumor, patients develop bad breath.
The disease has a high metastasis rate. In 75-80% of first-time patients, there are already metastases in regional lymph nodes. These often reach a larger size than the primary oropharyngeal tumor.
In 20% of patients, the neoplasm appears in the root of the tongue region. It disrupts the mobility of the organ, makes speech difficult, and makes patients uncomfortable when swallowing.
In 10% of patients, the primary tumor appears in the soft palate. Patients complain of pain, impaired speech, and swallowing.
In 5% of patients, the primary neoplasm is localized on the posterior wall of the oropharynx.
At the time of diagnosis, 15-30% of patients have distant metastases. The lungs and bones are the most commonly affected areas.
Principles of treatment
The preferred treatment method is surgery. Doctors in Germany perform operations for patients with oropharyngeal cancer using both a conventional, mechanical instrument and a laser.
The surgical interventions are as follows:
- open – through skin incisions;
- transoral – through the oral cavity.
Transoral interventions are considered the preferred ones. They are less traumatic, provide a better aesthetic result, and better functional outcomes. Nonetheless, these surgical interventions are also more complex and are best performed in a specialized medical center with more experience present. Therefore, many patients with oropharyngeal cancer prefer to receive the services of German doctors.
The operation is complemented by lymph node dissection: unilateral or bilateral.
Other primary treatment options:
- radiotherapy – as an independent version, it is safer for health;
- chemoradiotherapy – it is more toxic but also more effective.
If surgery is chosen as the first method of treatment of oropharyngeal cancer, then the indications for postoperative radiotherapy and chemotherapy are determined individually. Adjuvant therapy in Germany is carried out when the tumor invades the capsule of the lymph node, as well as in the case of a positive resection margin. In the second case, a second surgery can also be performed.
If the first treatment for cancer was radiotherapy or chemoradiotherapy, then, after its completion, the patient is examined to check if there is a residual tumor. If it has regressed completely, additional treatment is not required. If there is a residual tumor, surgery is required for its removal.
In the advanced stages of oropharyngeal cancer, the treatment is usually conservative. The main options include:
- chemoradiotherapy;
- induction chemotherapy followed by chemoradiotherapy.
Some patients may undergo tumor removal surgery. If the risk of recurrence is high, postoperative radiation therapy or chemoradiotherapy is conducted.
Surgical treatment
In medical hospitals in Germany, surgical interventions are performed by surgeons who specialize in head and neck oncology. Therefore, you can be sure of good oncological results and minimal health risks.
Primary tumor removal is performed using an en-bloc technique. The doctor moves back from the margin of the visible neoplasm by at least 2 cm. After the operation, the material is examined. Good treatment results are predicted with a negative resection margin and a distance to cancer cells of at least 5 mm.
In specialized oncology hospitals in Germany, doctors often treat patients with a laser. The tumor is removed with access through the oral cavity, without skin incisions. If this is not possible, then a standard open operation is performed.
The tumor removal is followed by a reconstructive stage. Doctors can perform a resection of the adjacent organs that need to be restored: for example, a fragment of the lower jaw. It is restored with implants or autologous bone. In the future, the patient may need dental implants to restore their chewing function.
After the operation, some tissue defects will remain. In Germany, they are replaced with advanced or free flaps. In patients with defects on their skin, the doctor can perform a transplant to improve the person's appearance.
Lymph node dissection is a stage of surgery aimed at removing lymph nodes. It is required for most patients. Lymph node dissection is performed, even in the absence of clinical signs of damage to the lymphatic collector, in the following cases:
- locally advanced cancer (T3, T4);
- primary tumor in the tonsils (these make up two-thirds of cases of oropharyngeal cancer);
- tonsillar fossa lesions;
- cancer recurrence.
In addition, lymph node dissection is indicated by the presence of at least one metastasis over 6 cm, multiple metastases over 3 cm, or the spread of the metastatic tumor beyond the lymph node capsule (to the jugular vein, common carotid artery, or sternocleidomastoid muscle).
Contraindications for surgery to treat oropharyngeal cancer are as follows:
- invasion of the neoplasm in the mediastinum;
- lesions of the prevertebral fascia and cervical vertebrae;
- the spread to the skin from the regional lymph nodes.
In these cases, radical tumor removal is unlikely, and the risk of complications is high. Therefore, in Germany, such patients are usually treated with conservative methods.
Radiotherapy
Radiotherapy is one of the three main methods of treatment in oncology. In Germany, it is used both as an independent option and in combination with chemotherapy.
Proton therapy is considered the preferred treatment option for oropharyngeal cancer. However, this is an expensive, high-tech method that is only available in countries with advanced medicine. There are six Proton Therapy Centers in Germany, more than in any other country in Europe. Most foreign patients who receive medical services in Germany are treated at the University Hospital Heidelberg or the University Hospital Essen.
Proton therapy differs from standard photon therapy, in that it delivers radiation to the target more accurately. Protons particularly, do not damage the tissues through which they pass. They release most of their radiation only when they reach the tumor. As a result, there is less radiation exposure to the surrounding tissues, and a lower risk of post-radiation complications. This is especially important in head and neck cancer, because many important organs, large vessels, and nerves are located nearby, which increases the risk of side effects.
IMRT or VMAT are the preferred methods of photon radiation therapy if proton therapy cannot be performed for technical or financial reasons. These are new options for radiotherapy, and they are safer and very accurate. Doctors irradiate the primary tumor, or its bed, after surgical removal, as well as the site of the lymphatic collector.
Postoperative radiotherapy is optimally started within 6 weeks of surgery, immediately after the wound healing. The interval should not exceed 12 weeks.
Brachytherapy is a method of contact radiation therapy. It is used in specialized centers in Germany. It involves the implantation of radioactive seeds into the tumor. This therapy is only used at an early stage and can destroy small neoplasms.
Drug therapy
The main method of drug treatment is chemotherapy. Platinum-based medications are most effective for oropharyngeal cancer. In Germany, they are often used simultaneously with radiotherapy. Typically, doctors prescribe a three-drug regimen. In total, 2-3 courses, with an interval of 3 weeks, are required.
In oncology, drugs for targeted therapy and immunotherapy are increasingly being used:
EGFR inhibitors slow or stop the growth of cancer cells. The effect is achieved by inhibiting the protein that stimulates the tumor growth. The drugs of this group are used not only in the advanced, but also in the early stages of cancer. They are combined with chemotherapy and radiation therapy. These drugs are safer for a patient’s health compared to chemotherapy. Therefore, they are sometimes used instead of platinum-based medications if the patient's health condition does not allow him to endure standard chemotherapy.
PD-1 inhibitors are drugs that enhance antitumor immunity. They are called immune checkpoint inhibitors. These drugs are prescribed as second-line therapy for patients whom chemotherapy and targeted therapy no longer work for. The drugs do not have a cytotoxic effect on cells, but only eliminate the protection of the tumor against the immune response. Therefore, they are relatively safe for health, although some people may have autoimmune reactions.
Why is it worth undergoing cancer treatment in Germany?
Germany offers highly developed medicine. Therefore, many neck cancer patients, patients with oropharyngeal cancer, and other head and neck tumors, prefer to treat their oncological diseases in this country. The country provides top-class medical services. Doctors successfully cope with the treatment of nasopharyngeal, oropharyngeal, laryngopharyngeal, oral cavity neoplasms, and other types of cancer.
Here are a few reasons for you to use the medical services of German doctors:
- state-of-the-art equipment in hospitals due to good financing of medicine;
- you will receive treatment from highly reputable doctors in the world of medicine;
- sparing transoral (from inside the oral cavity) operations, with minimal health risks;
- reconstructive and plastic stages of the surgery will restore the patient’s appearance and swallowing and chewing functions;
- new radiotherapy options: very precise, non-damaging to organs and tissues surrounding the tumor, safe for the patient's health;
- large Oncology Centers use proton therapy, which is the safest and most effective radiotherapy option for oropharyngeal tumors;
- doctors working in the Departments of Oncology will treat the disease with the help of modern drugs: this is not only by chemotherapy, but also targeted therapy and immunotherapy.
To undergo treatment of oropharyngeal cancer 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 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 diagnosis and treatment of oropharyngeal cancer and achieve the best results.
- We will help you to overcome the language barrier and establish your communication with the doctor at the German hospital.
- The waiting time for the diagnosis and treatment will be reduced, 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 elimination 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 repeat the previously performed diagnostic procedures.
- We will stay in contact with the German hospital after the completion of your treatment.
- We will arrange additional diagnosis 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 are taking care of your health, the Booking Health staff will help to reduce the cost of treatment in Germany and take care of all the travel arrangements.
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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