Tracheal Cancer. Treatment in Germany
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Tracheal cancer in Germany is treated using surgical techniques and radiation therapy. To restore the patency of the organ and normalize respiratory function, endoscopic procedures are performed. Chemotherapy is rarely used in Germany, as it is not very effective for this disease. Chemotherapy is sometimes provided at the advanced stage of tracheal cancer, alone or in combination with radiation therapy. To get the best results with minimal risk of complications, you can undergo tracheal cancer treatment in Germany.
Content
- What is tracheal cancer?
- Principles of treatment
- Surgical treatment
- Radiation therapy
- Treatment results
- Endoscopic treatment
- Why is it worth undergoing treatment in Germany?
What is tracheal cancer?
Tracheal cancer is a group of malignant neoplasms which develop from the mucous membrane of the corresponding organ. This is a rare type of cancer and accounts for 0.2% of cases of all oncological diseases. Basically, the trachea is affected by two types of cancer:
- squamous cell carcinoma (50% of cases);
- adenoid cystic carcinoma (30% of cases).
The main risk factors for tracheal squamous cell carcinoma are smoking (the main cause), inhalation of hydrocarbons, and genetic predisposition. Most cases of the disease develop in patients aged 60-70 years. The cause of adenoid cystic carcinoma has not been established. The disease mainly develops in people who are 30-50 years old.
Rare types of tracheal cancer:
- mucoepidermoid carcinoma;
- small cell neuroendocrine carcinoma;
- large cell neuroendocrine carcinoma;
- chondrosarcoma;
- leiomyosarcoma.
In the early stages, tracheal cancer manifests no symptoms. Symptoms develop only when the tumor closes the lumen of the organ and prevents breathing. Wheezing and noisy breathing, as well as shortness of breath, occur when the trachea is obstructed by two-thirds or more. Cancer may cause a cough and hemoptysis, while the tumor invasion into the recurrent laryngeal nerve causes hoarseness.
Not all tumors detected in the trachea are primary neoplasms that initially developed there. More often, laryngeal, lung, thyroid, or esophageal cancers invade the trachea.
Principles of treatment
The main treatment for any cancer is surgery, but not all patients are considered candidates for surgery. In many cases, the disease is detected late, in an inoperable stage. In such situations, radiation therapy becomes the main treatment option.
When performing a surgical intervention, the doctor seeks to remove the tumor completely, along with the lymph nodes. The intervention can be performed through incisions in the neck or chest, depending on the tumor location. After surgery, many patients undergo radiation therapy.
In inoperable cases, radiation therapy becomes the main treatment method. It is especially effective in adenoid cystic carcinoma, but less effective in squamous cell carcinoma. Doctors use high doses of radiation, and in half of patients with adenoid cystic carcinoma, the tumor can be completely destroyed.
Many patients require endoscopic procedures to eliminate respiratory failure. Respiratory failure is associated with tumor obstruction of the trachea. Doctors remove or destroy the tumor in the lumen of this organ, and then place a stent in order to avoid repeated obstruction. Endoscopic treatment is carried out at the preparation stage for radical surgery, or radiation therapy, and, in the advanced stage of the disease, it is used as palliative treatment for symptom relief, prevention of severe complications, and increasing the patient's life expectancy.
Surgical treatment
Surgical treatment is considered the main and most effective treatment. If the doctor removes the tumor completely, then the probability of a complete cure of the disease is high: especially with a less aggressive, adenoid cystic cancer.
Surgical access depends on the location of the tumor:
- Cervicotomy – an incision is made in the neck from the hyoid bone to the suprasternal notch. The doctor dissects the soft tissues of the neck to the trachea, including the thyroid isthmus.
- Cervicotomy and partial longitudinal sternotomy – an incision is made on the neck and on the chest in the center of the sternum. It is required for damage to the upper thoracic and middle thoracic trachea.
- Posterior thoracotomy – an incision is made along the fourth intercostal space if it is necessary to remove the tumor in the tracheal bifurcation. The doctor has the opportunity to perform the necessary manipulations on the main bronchi.
- Complete median sternotomy – an incision is made in the center of the sternum. This is a more traumatic intervention option, so it is rarely used. This option is used when the tumor is located at the site of the tracheal bifurcation.
For cancer treatment in Germany, operations are performed not only at stages 1-2, but also, in some cases, at stage 3 if the patient's health condition allows him to have a traumatic operation. Nonetheless, radical interventions are not performed in a case of secondary changes in the lungs and heart due to long-term respiratory failure.
During the treatment of laryngeal lesions, doctors try not to mobilize the larynx in order to avoid swallowing dysfunction and vocal cord paresis. But, in some situations, the organ has to be removed. It is also possible to partially remove the esophagus, bronchi, and lungs, if they are involved in the cancer process. The specialists perform lymph node dissection: removed lymph nodes are examined to identify cancer cells in order to accurately determine the stage of the disease. Lymph node removal also has a therapeutic purpose: it reduces the risk of regional cancer recurrence. To prevent the kink of the left main bronchus and the left branch of the pulmonary artery under the aortic arch after super-extended resections, it is possible to remove the upper lobe of the lung on the right with repeated implantation of the left main bronchus into the intermediate bronchus.
Radiation therapy
For the treatment of tracheal cancer, radiation therapy can be used in the following cases:
- before surgery, to shrink the tumor before removing it;
- after surgery, to prevent relapse;
- as the main treatment for an inoperable cancer, sometimes in combination with chemotherapy.
The treatment of patients with advanced tracheal cancer with neoadjuvant radiation therapy has become increasingly rare in recent years. This is due to the fact that preoperative irradiation increases the risk of complications in the postoperative period: an anastomotic leak (connection of the airways after a tracheal resection) and pneumonia.
Indications for postoperative radiation therapy:
- locally advanced tracheal cancer;
- positive resection margin after the removal of a localized tumor (detection of cancer cells at the border of the removed tissue according to the results of a histological examination of the surgical material).
Radical radiation therapy is provided to patients who do not undergo surgery to cure their cancer. The chances of curing the disease are lower than when using a surgical technique. But, in a case of contraindications to surgery, this treatment method ensures the long-term survival of patients.
Radical radiation therapy uses higher doses of radiation than postoperative radiation. The method works best for adenoid cystic cancer. It provides a five-year survival rate of 75% and a ten-year survival rate of 55%. In about half of patients, after a course of radiation therapy, the tumor significantly decreases in size, and in the other half, it disappears completely.
The most common complication of therapy is radiation-induced esophagitis (esophageal inflammation). The most severe complication is the formation of a tracheoesophageal fistula. Doctors in Germany use new types of radiation therapy: very precise, leaving minimal damage to healthy tissues. If you are treated in a German hospital, you are less likely to suffer from post-radiation complications.
Treatment results
In most cases, tracheal cancer is diagnosed in the locally advanced stage. Every third patient has metastases in the lymph nodes of the mediastinum and lungs, which is considered a contraindication for surgical treatment. Only a few patients can be operated on. Therefore, the survival rates of patients remain low: five-year is 15% and ten-year reaches 7%.
However, the prognosis is much better in those who have undergone radical surgery. It is possible at stages 1 and 2. After surgical treatment of patients with tracheal cancer, the five-year survival rate reaches 50% and the ten-year survival rate is 35%. If after the surgical intervention, the patient is treated with radiation therapy, then the five-year survival rate reaches 72%.
The best results are achieved in treatment of adenoid cystic cancer, as it is less aggressive than squamous cell carcinoma. The five-year survival rate after combination treatment is 92%, while the ten-year survival rate reaches 79%. If no cancer cells were found in the resection margins after the tumor removal, then the figures are even higher: 96% and 83%, respectively.
The prognosis is worse for squamous cell cancer, as it is more aggressive, recurs, and metastasizes more often. After combination treatment (surgery and radiation therapy), the five-year survival rate of patients is 41% and the ten-year survival rate is 16%.
Endoscopic treatment
Endoscopic treatment in Germany is carried out without skin incisions. Doctors insert long instruments and a video camera with a light, through a tube placed into the trachea through the mouth and larynx.
The main manipulations that are performed during an endoscopic treatment are as follows:
- tumor removal;
- tracheal stenting (implantation of a frame that keeps the trachea open and prevents its obstruction).
Endoscopic treatment is often performed on first-time patients, regardless of the stage of their disease, as well as on cases of further treatment tactics. The main goal of an endoscopy is to eliminate a tumor obstruction. Once the patient is able to breathe normally, their condition will improve and doctors can perform a radical surgery for cancer removal or conduct radiation therapy.
Grades of stenosis:
- Grade 1 – the lumen of the trachea is less than half closed;
- Grade 2 – more than half closed, but less than two-thirds closed;
- Grade 3 – tumor stenosis of more than two-thirds of the normal diameter.
At the time of contacting a doctor, most patients have a grade 2 or 3 stenosis, with a threat of developing critical respiratory failure.
Options for tracheal dilation during an endoscopic procedure:
- tumor removal using a surgical instrument, laser, electrocoagulation, or photodynamic therapy;
- bougienage of the narrowed site (stretching).
To prevent repeated tracheal stenosis, a stent is placed inside:
- a plastic stent is safer, but provides a short-term effect (it is suitable for those who are scheduled to undergo radical surgery or radiation in the near future);
- a metal, self-expanding stent provides a long-term result, it is used in patients with inoperable tumors, for whom chemotherapy and palliative radiation become the main treatment method.
The metal stent placement often does not require additional procedures for tracheal dilation. It can perform its function for years. In a case of repeated tumor obstruction, repeated stenting is possible, including the stent-in-stent technique. In some patients, the stents change their position. The most common cause is from scarring due to radiation therapy. In such patients, the stents are removed. As a rule, the implantation of a new one is not required, since the tumor shrinks after radiation exposure and no longer prevents breathing. As the cancer progresses, the stent may be implanted repeatedly.
Why is it worth undergoing treatment in Germany?
Germany offers advanced medicine. Most cases of adenoid cystic tracheal cancer and many cases of squamous cell cancer are cured in this country. Good results are achieved even in cases of aggressive neoplasms at advanced stages. Doctors use radical surgery, radiation therapy, chemotherapy, and endoscopic procedures.
There are a few reasons for you to undergo treatment in Germany:
- radical operations not only for localized, but also for locally advanced cancer;
- whenever possible, doctors prefer less invasive options for the surgical intervention: for example, doctors will make an incision between the ribs instead of an incision in the center of the sternum;
- in most cases, the tumor can be removed completely, with a negative resection margin, which ensures the highest survival rate of patients;
- after the removal of the neck organs, a reconstructive stage is performed to restore breathing, swallowing, and speech functions;
- adenoid cystic cancer can be cured without surgery, with the help of radiation therapy, which is carried out based on a radical program;
- the use of new, very precise radiation options, which rarely cause severe esophagitis, tracheoesophageal fistulas, and other complications;
- in the advanced stages of tracheal cancer, doctors in Germany use modern chemotherapy regimens based on the international protocols;
- the use of high-tech endoscopic procedures to restore tracheal patency: laser tumor destruction, photodynamic therapy, and tracheal stenting.
To undergo tracheal 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 faster 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 tracheal cancer treatment and achieve the best results;
- We will help you to overcome the language barrier and establish your communication with a doctor at the German hospital;
- The waiting time for diagnostics 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 any previously performed diagnostic procedures;
- We will keep in touch with the German hospital after the completion of your treatment.
- We will arrange additional diagnostics 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 reduce your 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. 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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