Treatment of Salivary Gland Cancer in Germany
Best hospitals and doctors for salivary gland cancer treatment in Germany
Leading hospitals
Cost for treatment
Salivary gland tumors are rare oncological neoplasms. They are treated with surgery in the early stages, and in the advanced stages, doctors use radiation therapy and chemotherapy. Tumors can develop from the three major salivary glands: parotid, sublingual, and submandibular, as well as from minor salivary glands, which are located throughout the oral cavity.
Content
Surgical treatment
Most cases of salivary gland cancer are treated with surgery. This is the most effective treatment method, providing the possibility of a complete recovery. The doctor begins the treatment of gland cancer with surgical intervention if, according to the patient's diagnostic results, he concludes that the tumor can be eradicated.
The doctor removes the salivary gland and adjacent tissues. The surgical material is then sent for histological examination. If the resection margin is clean (there are no tumor cells at the margin of the removed tissue), then the scope of the operation is considered adequate. The risk of recurrence is low. Should cancer cells be detected, doctors will conduct an additional stage of treatment for salivary gland cancer: cervical lymph node dissection.
Here below are listed the types of surgery, depending on the location of the gland cancer:
Parotidectomy is surgical removal of the parotid salivary gland. The surgical intervention is complicated because salivary gland cancer is located near the facial nerve. The facial nerve controls movements on one side of the face. The incision for this operation is made in front of the ear. Sometimes it reaches the neck.
Most cases of salivary gland cancer begin in the outer portion of the salivary gland. It is called the superficial lobe. The operation to remove it is called superficial parotidectomy. In this case, the facial nerve is not damaged, which avoids the development of neurological complications.
Sometimes the tumor grows into the facial nerve. In this case, it must be partially removed. The nerve is repaired by suturing the ends or using a graft. Immediately after the operation, the patient may have facial muscle weakness or facial muscle paralysis. After a few days, symptoms are greatly relieved if the nerve is intact. The symptoms persist for several weeks or months if the nerve is cut totally or partially. Permanent facial paralysis is rare.
Submandibular or sublingual gland removal is performed in case of cancer of these glands. The doctor performs total removal of the gland damaged by the tumor. It is often required to perform resection of a part of the surrounding tissue, including bone. Such operations require a reconstructive stage. The doctor can restore a part of the lower jaw with an implant. Many patients will need dental implants to restore the chewing function of the dentoalveolar system. There are nerve endings in the submandibular and sublingual salivary glands, which are responsible for the movements of the tongue, taste sensations and the mobility of the muscles of the lower part of the face. Some of these nerves may need to be removed, which may cause neurological symptoms. Gradually they decrease.
Minor salivary gland surgery – tumors are removed through the mouth or a skin incision. Salivary gland cancer can appear anywhere: on the tongue, lip, palate, throat, and larynx. The doctor chooses the most convenient way to remove the neoplasm, depending on the location. In any case, gland cancer is totally removed. The physician strives to achieve clean resection margins to avoid recurrence. A reconstructive plastic stage follows the operation to restore the function of organs and the appearance of a person.
Here are some of the possible side effects of the operation:
- Problems with tongue movement, speech, or swallowing will usually resolve or improve within a few months.
- Frey's syndrome is the result of an improper fusion of severed nerves. They are connected with the sweat glands of the face. As a result, while chewing, a person turns red and sweats. The problem can be solved with drugs. Some patients will need additional surgery to eliminate this complication.
- Defects in appearance are eliminated with the help of plastic surgery. Doctors perform skin grafting.
- Functional defects are mainly associated with damage to the lower jaw or intersection of the nerve endings. Doctors can suture the nerves together or repair them with grafts. The lower jaw is restored with artificial materials or autologous bone.
Neck lymph node dissection is a possible stage of the operation to remove salivary gland cancer. Indications for this surgery are as follows:
- swollen lymph nodes, determined by the results of computed tomography or other medical imaging;
- accumulation of the radionuclide in the lymph nodes according to the results of positron emission tomography;
- high-grade gland cancer.
Neck lymph node removal has two goals: diagnostic and therapeutic. Doctors can detect metastases that are not clinically detectable by examining distant lymph nodes. As a result, the pathomorphological stage of the disease is specified, which determines the further treatment options after surgery. In addition, metastatic lymph node removal reduces the risk of regional cancer recurrence.
The more lymph nodes and their surrounding tissues are removed, the lower the risk of tumor recurrence. On the other hand, a larger number of removed nodes makes the operation more traumatic and more likely to have complications. Therefore, doctors strive to find a middle ground: to perform lymph node dissection in the minimum scope, which allows them to prevent the recurrence of salivary gland cancer with the maximum probability.
Sentinel lymph node biopsy is an intraoperative diagnostic procedure performed in German hospitals. In many patients, it avoids cervical lymphadenectomy for salivary gland cancer. The sentinel node is called the lymph node, the first to collect lymph flowing from the tumor. Suppose metastases develop somewhere, then first of all, here. If there are no metastases in the sentinel lymph node, their presence in the lymph nodes located farther from the tumor is also unlikely.
Lymphoscintigraphy is performed to find sentinel lymph nodes. Doctors inject a radioactive substance into the area of the tumor, and then use a gamma camera to check where it accumulates. Lymph nodes into which the substance has penetrated are removed and examined. If there are no signs of oncology, cervical lymph node dissection is not required. If metastases are detected, the patient is indicated to undergo neck lymph node removal.
The cost of surgical treatment for salivary gland cancer ranges between 7,100 EUR and 11,400 EUR.
Radiation therapy
Radiation therapy is one of the main treatment options for head and neck oncology. The treatment can be used in the following cases:
- as the main treatment option for patients with an unresectable tumor (if the doctor, based on the diagnostic results, concluded that total removal of the salivary gland neoplasm is unlikely);
- the main treatment option, if there are medical contraindications for surgery, or the person refuses surgery for gland removal;
- after surgery – so that the tumor does not recur after treatment;
- treatment for stage of salivary gland cancer with metastases – to relieve symptoms, eliminate hemorrhage and difficulty swallowing.
German hospitals use new techniques for radiation therapy. Intensity-modulated radiation therapy (IMRT) is preferred. It allows the doctors to destroy the salivary gland tumor with the help of radiation, avoiding a significant radiation load on the healthy organs. IMRT uses a machine that moves around the patient and directs beams at different angles. Doctors can adjust the intensity of the beams so that the radiation does not damage healthy tissue. Most major cancer hospitals in Germany use IMRT as the standard method of irradiating head and neck tumors.
Innovative radiation therapy methods that are available in some specialized cancer hospitals:
Continuous hyperfractionated accelerated radiotherapy is a new approach to tumor irradiation, which involves the delivery of the required dose of radiation at an accelerated pace. The patient receives radiation once a day, five days a week, for about six weeks with standard treatment. However, accelerated hyperfractionated radiation therapy involves frequent irradiation sessions: 2-3 times a day, and single doses of radiation are reduced.
Proton therapy uses protons instead of photons as a source of radiation. This is the most advanced method of radiation therapy, but it is expensive and available only in some oncology hospitals. There are six proton therapy centers in Germany, which is more than in any other country in Europe. Most foreign patients are treated in Heidelberg or Essen, as the university hospitals in these cities have the largest mobile gantry machines.
The peculiarity of protons and their main advantage over photons is that these particles release most radiation only inside the target. On the way to it, a minimum amount of radiation is released, which avoids damage to the healthy tissues. As a result, doctors can reduce the risk of side effects and safely increase the dose of radiation to the tumor, obtaining better oncological results.
The following side effects of therapy caused by irradiation of healthy tissues are possible:
- skin changes resembling sunburn;
- dysphagia;
- nausea;
- fatigue, weakness.
Most of the side effects of radiation resolve quickly upon completing the course of therapy.
Due to damage to the salivary glands, radiation can cause dry mouth. Sometimes there is a sore throat, ulcers in the mouth and throat, hoarseness, and loss of teeth. In some patients, radiation damages the thyroid gland, weakening its function over several months or years. Hypothyroidism may develop, which will require thyroxine replacement therapy. The use of new radiation therapy options will reduce health risks and also be more likely to help cure oncology.
Chemotherapy
Chemotherapy for salivary gland tumors is often combined with radiation therapy. This is a systemic treatment. It involves the penetration of drugs into the systemic circulation. The drugs penetrate all organs and tissues, affecting not only the tumor in the salivary gland, but also metastases.
Doctors usually prescribe chemotherapy using combinations of 2 or more drugs. The patients weakened by the disease are treated with a single drug.
There are no standard treatment regimens. This is because salivary gland cancer is rare. In addition, these are tumors of different histological types. Therefore, it is difficult to carry out large trials to determine which drug combinations work best in which cases.
Why is it worth undergoing treatment in Germany?
With the salivary gland tumor detected, you can seek help from one of the German hospitals to undergo top-class medical care. This is a country with developed medicine. Germany employs highly qualified specialists who are considered among the best in the world in the treatment of head and neck tumors. The hospitals are equipped with state-of-the-art technology. Germany has the latest treatment methods, which are not yet available in other countries.
There are a few reasons for you to undergo therapy in Germany:
- Most operations are successful: doctors manage to obliterate the tumor with clean resection margins, which reduces the risk of the salivary gland tumor recurrence.
- Minimal risk of facial nerve damage.
- If doctors have to remove part of the facial nerve, it is sutured or repaired with a graft to avoid facial muscle weakness and paralysis.
- A Sentinel lymph node biopsy is performed, which allows some patients to avoid lymph node dissection.
- Neck lymph node dissection can be performed endoscopically to improve the aesthetic outcomes of the operation.
- In the case of mandibular resection, the bone is restored with an implant to regain chewing function.
- Skin grafting is performed to improve the aesthetic outcomes of the operation.
- Advanced irradiation options are available. Physicians use continuous hyperfractionated accelerated radiotherapy to improve oncological outcomes. Some hospitals irradiate tumors with protons.
- Modern drugs for chemotherapy.
- High-quality care and maintenance therapy.
To undergo medical treatment for cancer of the salivary 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 for oncology services 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 Booking Health medical tourism facilitator. Our employee will contact you, hold a consultation, and answer 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 oncology hospital, whose doctors specialize in the treatment of salivary glands and achieve the best results.
- We will help you overcome the language barrier and establish contact with the doctor in 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 the lack of overpricing and additional coefficients for foreign patients.
- Our specialists will solve any organizational issues: paperwork, transfer from the airport to the German oncology hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You will not have to undergo previously performed diagnostic procedures.
- We will keep in touch with the German hospital after completing the cancer 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 your travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. 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!
Sources:
