Treatment of Parotid Gland Cancer in Germany

Parotid gland cancer is a group of malignant tumors in the corresponding organ. They have a different histological types and differ in their grade. Most cancers can be cured by surgery. After surgery, as well as for unresectable tumors, radiation therapy becomes the primary treatment method. At the metastatic stage, doctors resort to chemotherapy. To reduce the risk of tumor recurrence and avoid complications, you can undergo parotid gland cancer treatment in Germany.

Content

1. What is parotid gland cancer?
2. Diagnostics
3. Surgical treatment
4. Radiation therapy
5. Chemotherapy
6. Why is it worth undergoing treatment in Germany?

What is parotid gland cancer?

There are three pairs of major salivary glands in the human body: parotid, sublingual, and submandibular. There are also many minor salivary glands. They are located in the mouth and various ENT organs.

Parotid gland cancer is the most common cancer of the salivary glands. It accounts for 70% of all cases.

However, in general, parotid gland cancer is sporadic. Benign tumors develop in this area more often than malignant ones. If left untreated for a long time, some benign neoplasms become malignant.

Tumors of various histological types may develop in the parotid gland. They are classified according to their grade, from the first to the third. Grade 1 (G1) cancer is called highly differentiated. It grows slowly, the cancer cells are the most mature, and the prognosis for such patients is favorable. The most dangerous are grade 3 (G3) tumors. They grow rapidly, spread metastases, and often recur even after complete removal.

Here are the most common types of parotid gland cancer: 

• mucoepidermoid carcinoma is the most common cancer, usually G1, but G2 and G3 tumors also occur;
• adenoid cystic carcinoma usually has a high grade and occurs infrequently, it may recur many years after its removal;
• adenocarcinoma (most often acinic cell);
• mixed tumors.

Squamous cell carcinoma, epithelial-myoepithelial carcinoma, anaplastic small cell carcinoma, undifferentiated small cell carcinoma, large cell carcinoma, and lymphoepithelial carcinoma are very rare. Sometimes non-Hodgkin's lymphoma begins to grow in the parotid glands. Sarcomas or metastases of cancer of another localization in the parotid glands are also very rare.

Risk factors for developing parotid gland cancer are as follows: 

• elderly age; 
• male gender; 
• previous radiation therapy; 
• burdened heredity; 
• occupational hazards: nickel alloy dust, silica dust. 

The disease proceeds in four stages: 

Stage 1 – a tumor up to 2 cm, not invading the adjacent tissues. 

Stage 2 – a tumor up to 4 cm, not spreading to the nearby tissues. 

Stage 3 – a tumor is more than 4 cm, spread to the surrounding tissues, the appearance of 1 metastasis in the lymph node on the side of the lesion. A metastatic tumor has not spread beyond the lymph node. The lymph node itself does not exceed 3 cm in diameter.

Stage 4 – is divided into A, B, and C. At stage 4A, the tumor can spread to the jaw, skin, ear canal, and facial nerve, and metastases up to 6 cm in size may appear. At stage 4B, multiple metastases in the lymph nodes, the spread of the metastatic tumor outside the lymph node, and damage to the skull and carotid artery base are possible. At stage 4C, distant metastatic foci appear, most often in the lungs.

Diagnostics

Salivary gland tumors are rare, so they are not screened. 

Patients usually go to the doctor after the onset of symptoms. With gland cancer, the reasons for visiting the doctor are as follows:

• swelling in the neck or on the cheek; 
• earache; 
• increase in the size of the cheek; 
• numbness of a part of the face; 
• muscle weakness on one side of the face; 
• inability to open the mouth wide or the occurrence of pain when opening the mouth;
• discharge from the ear;
• dysphagia (difficulty swallowing).

Symptoms of benign and malignant neoplasms are the same. Many clinical manifestations are associated with facial nerve lesions.

Diagnostic methods: 

• X-ray imaging – the tumor can be seen on the image;
• Contrast-enhanced MRI or computed tomography – the imaging tests determine the size and location of the tumor, invasion in the adjacent tissues, metastases in the lymph nodes;
• PET – helps to find metastases in the lymph nodes and distant organs. 

A biopsy is performed to confirm the diagnosis. It allows doctors to obtain a piece of tissue to send it to the laboratory and determine whether the formation detected in the parotid gland is benign or malignant.

Biopsy options: 

• fine-needle aspiration biopsy is less accurate, and it is used when the likelihood of the malignant tumor is low; 
• Incisional biopsy is the primary option for confirming the diagnosis. In the case of suspected cancer, the doctor removes a small fragment of the tumor with a scalpel. 

The biopsy is not a mandatory part of the patient's examination. Suppose the tumor is resectable, and medical imaging shows it is highly likely to be cancer. In that case, the doctor may remove cancer before it is examined in a laboratory to determine its histological type and grade.

Surgical treatment

Surgery is the main treatment option in the operable stage. The operation scope depends on the tumor size and metastases in the lymph nodes.

The treatment options include: 

• partial parotid gland removal (superficial parotidectomy);
• total parotid gland removal (total parotidectomy).

The goal of the surgery is altogether to remove the tumor with the capture of healthy tissue. The surgery is followed by the histological examination of the surgical material. Doctors check for cancer cells at the border of the removed tissue. If the resection margins are clear, the tumor has been completely removed.

With partial parotid gland removal, the facial nerve is not usually affected. Total removal requires its crossing. In some cases, a part of the nerve is removed. The doctors in German hospitals strive to cure cancer, avoiding neurological complications. Therefore, they suture the facial nerve after tumor removal, and if a significant part of it is removed, they repair it with a graft. After the surgery, control over the facial muscles on the side of the facial nerve damage is lost. But after a few days, these symptoms are relieved, and over the next few months, the nerve is restored, and the neurological manifestations disappear.

With large tumors, doctors have to remove not only the salivary gland, but also adjacent tissues. This operation leads to functional and aesthetic defects. The German surgeons perform a reconstructive plastic stage of the surgery to restore lost functions. Skin grafting helps hide aesthetic flaws.

Some patients require cervical lymphadenectomy. It is performed in different scopes: selective, modified, radical. Surgeons remove lymph nodes and other neck tissues, including nerves and prominent veins. The more tissue removed, the lower the risk of tumor recurrence, but the worse the health consequences. Therefore, doctors strive to find a balance: remove enough lymph nodes so that cancer does not recur, while minimizing the risk of side effects.

Indications for cervical lymph node dissection include: 

• high-grade cancer;
• lymph node metastases detected with PET;
• increase in the size of the lymph nodes of the neck; 
• positive sentinel lymph node biopsy. 

A sentinel lymph node biopsy is a high-tech procedure used in leading German hospitals to detect metastatic lesions of the lymph nodes if there are no clinical signs of metastasis. For many patients, this procedure means the possibility of avoiding lymph node dissection and, therefore, the associated health risks.

Sentinel nodes are several lymph nodes that collect lymph from the tumor first. The doctor's task is to identify them, remove them and send them to the laboratory. They are examined, and if no signs of cancer are found, there are no metastases in other neck lymph nodes. Therefore, there is no need to remove them. With metastases detected in the sentinel lymph nodes, the patient requires lymph node dissection in a standard scope, taking into account the stage of the disease and the grade of the neoplasm.

Lymphoscintigraphy is used to identify the sentinel lymph node. Doctors inject a radioactive substance into the tumor area and then check with a gamma camera in which lymph nodes it accumulates.

Radiation therapy

Radiation is the second most important treatment of parotid gland cancer after surgery. Radiation therapy can be used in the following cases:

• after surgery, if the risk of cancer recurrence is assessed as high (combination with chemotherapy is possible);
• instead of surgery – for treatment for stage at which the tumor is recognized as unresectable, as well as in case of medical contraindications to surgery and the patient refuses it;
• as the palliative treatment for an advanced stage of parotid gland cancer to relieve symptoms and reduce the risk of complications.

Doctors in Germany use radiation therapy options that are safe for health, which destroy cancer with radiation but minimally affect healthy tissue. 3D-CRT and IMRT are considered standard radiotherapy methods in the cancer centers of this country. Doctors irradiate the neoplasm from different sides so that when the beams pass, each section of healthy tissue receives less radiation. All beams converge on the tumor, so the radiation dose for the neoplasm is much higher.

Some hospitals in Germany use proton therapy. This therapy is an innovative irradiation method, which is often used for head and neck tumors. Salivary gland neoplasms are surrounded by functionally vital organs, large nerves, and blood vessels. It is essential to minimize damage to healthy tissues to avoid the development of post-radiation complications. Proton therapy makes it possible to destroy neoplasms as safely as possible for health.

Protons, unlike photons, release energy predominantly within the tumor. On the way to it, radiation is almost not released into the healthy tissues.

Here are some of the possible health effects of radiation therapy: 

• temporary side effects: skin redness, sore throat, mouth ulcers, weakness, fatigue;
• tooth loss;
• dry mouth; 
• decreased thyroid function;
• swallowing problems.

With new radiation therapy options, health risks will be lower.

Chemotherapy

Chemotherapy for salivary gland cancer treatment usually uses combinations of 2 or more drugs. The scheme is selected individually, depending on the treatment goals, the patient's state of health, histological type, stage, grade of the neoplasm, and response to previous therapy.

Chemotherapy can be used in the following cases: 

• after surgery, sometimes in combination with radiation therapy; 
• as palliative treatment for advanced cancer. 

In general, chemotherapy is not commonly used for parotid gland cancer.

Why is it worth undergoing treatment in Germany?

Germany employs specialists who are considered among the best in the world. The hospitals in this country have state-of-the-art equipment. German hospitals use innovations that are not yet available in countries with poorly developed medicine.

Here are a few reasons for you to undergo gland cancer treatment in Germany: 

• sparing surgery, partial gland removal, if possible;
• most operations are thriving: the tumor is eradicated with a negative resection margin, which minimizes the risk of recurrence;
• if the facial nerve is damaged, it is sutured or repaired with the graft to prevent irreversible  facial muscle paralysis on the side of the surgery performed;
• tissue defects after tumor removal are closed with advanced and free flaps;
• skin grafting is performed to achieve an excellent aesthetic result if required;
• sentinel lymph node biopsy is performed, which in the early stages of cancer avoids lymph node dissection;
• lymph node dissection can be performed using a less traumatic endoscopic technique;
• the use of innovative radiation therapy options, including proton therapy.

To undergo diagnosis and treatment of parotid gland in Germany, you are welcome to use the Booking Health service. On our website, you can 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 faster for you, and the cost of treatment in Germany will be lower.

Please leave your request on the website of the medical tourism operator Booking Health. Our employee will contact you, consult, 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 an excellent German hospital whose doctors specialize in parotid gland cancer treatment and achieve the best medical results.
• We will help you overcome the language barrier and communicate freely with a doctor from the German hospital.
• The waiting period for medical diagnosis and treatment will be reduced for you, and you will receive medical care on the most suitable dates.
• We will reduce the price. The cost of treatment in Germany will be lower than usual due to eliminating overpricing and coefficients for foreign patients.
• Our specialists will solve any organizational issues: paperwork, transfer 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 the previously performed diagnostic procedures.
• We will keep in touch with the German hospital after the completion of treatment.
• We will arrange additional medical examinations and treatment if required.
• We will buy medicines in another 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 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. Nadezhda Ivanisova 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!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.

Sources:

National Library of Medicine

Johns Hopkins Medicine

Healthline