Head and neck cancer treatment in Germany: therapy and surgery

Innovative treatments for head and neck cancer in Germany provide excellent clinical results, and the price is acceptable for most medical tourists.

The term head and neck cancer include malignant neoplasms that occur in the head and neck area.

These include malignant tumors of the oral cavity (mouth, palate, and salivary glands), cancer of the larynx, tumors of the nasal cavity and paranasal sinuses, thyroid cancer and others.

Most malignant tumors in the head and neck are so-called squamous carcinomas, that is, tumors originating from surface cells.

Less common are adenocarcinomas, glandular tissue tumors that mainly affect the nose and paranasal sinuses, sarcomas, and other types of tumors.

There is no reliable information about the total number of malignant tumors of the head and neck. It is estimated that in Germany, 50 out of every 100,000 inhabitants suffer from head and neck cancer each year.

For comparison, 180 out of 100,000 people in the country get colorectal cancer each year. Breast cancer each year affects 136 out of 100,000 German women. In turn, prostate cancer, the most common cancer in men, is diagnosed annually in 145 out of 100,000 men.

According to the Robert Koch Institute, the most common cancer in the head and neck is throat cancer. Every year, this disease is diagnosed in 3,600 men and 500 women. The average age of onset is 68 years.

Possible symptoms

Malignant tumors of the head and neck cause different symptoms depending on their location.

Mouth cancer often causes pain

Tumors of the oral cavity are often manifested as painful changes in the mucous membrane (edema, discoloration, long-lasting ulcers). Depending on the location and size, the tumor may limit the mobility of the tongue and cause difficulty swallowing. Tumors of the salivary glands often cause painful swelling.

Persistent hoarseness is an alarming symptom

Symptoms of laryngeal tumors include persistent hoarseness, sore throat, chronic cough, difficulty swallowing, and pain radiating to the ear. Some patients note the foreign-body sensation in the throat. All these symptoms can be caused by different diseases, but they require a visit to a doctor for examination.

Diagnosis of head and neck cancer in Germany

The following examinations should be performed by a specialist in tumors of the head and neck (depending on the location of the tumor, this could be a specialist in ENT surgery or a maxillofacial surgeon):

Medical history and physical examination: starting $ 500

First, the doctor records the symptoms and history of their development, as well as risk factors. Visible areas of the mouth and pharynx are carefully examined. He can examine parts of the nose and ear, as well as deeper parts of the throat and larynx using the mirrors.

Endoscopic examination: starting $ 800

During the physical examination, doctor gets a first impression. The next step is endoscopic examination with biopsy. Samples taken from suspicious areas are examined under a microscope to determine the histological type of the tumor.

Ultrasound (sonography): starting $ 500

Ultrasound examination shows the spread of the tumor outside the organ.

With this simple and accessible method, the doctor can see enlarged lymph nodes. If necessary, a fine-needle aspiration biopsy of the lymph node is performed with a microscopic examination of aspirate (this procedure is not included in the price indicated above).

Computed tomography ($ 800) and magnetic resonance imaging ($ 1000)

Using computed tomography and magnetic resonance imaging, you can accurately determine the spread of the tumor. In addition, the doctor can detect secondary tumors (metastases) in other organs, such as the lungs. Unlike magnetic resonance imaging, computed tomography provides detailed information about bone structures located near the tumor. The advantage of MRI is that patients are not exposed to potentially dangerous X-rays.

Positron emission tomography ($ 1500)

Positron emission tomography is an innovative method for detecting metastases. During the scanning, the patient is given glucose loaded with a radioactively labeled substance. This molecule leaves a radioactive trace, which can be detected using a special technology.

Since the metabolic activity of tumor tissues is higher than normal, they are released on PET images.

Positron emission tomography is required only in exceptional cases. PET is not one of the standard procedures in the diagnosis of head and neck cancer. However, this method can provide valuable information in certain clinical situations.

Head and neck cancer treatment methods in Germany

Cancer treatment should begin as soon as possible. The specific approach depends on various factors, such as the histological type of the neoplasm, the size and stage of the cancer, and the state of health of the patient. For complete recovery, it is necessary to completely remove all tumor tissue and affected lymphatic effluent. If this goal cannot be achieved, doctors try to control the tumor as long as possible.

The basis of treatment is surgical methods, as well as radiation therapy and chemotherapy. All new methods, such as therapy with tumor-targeted monoclonal antibody, are usually integrated into existing treatment concepts.

Treatment of head and neck cancer in Germany is always planned by a multidisciplinary team of specialists. When planning therapy, the biological features of cancer cells, the size, localization, and tumor stage (TNM), as well as the age and condition of the patient are taken into account.

Most often, this treatment concept consists of a combination of different methods, among which surgical removal of the tumor plays a major role. As we said, a complete cure for cancer can only be achieved through the removal of a tumor.

Surgical removal (starting $ 10,000)

The main goal of the surgery is to completely remove the tumor along with the affected lymph nodes in the neck. In case of extensive tumors, some patients may require cosmetic surgery. In the case of throat cancer, an attempt is always made to preserve the larynx, but in many cases this is not possible.

Radiation therapy (from $ 8000)

Radiotherapy for head and neck cancer is performed after surgery (adjuvant radiation therapy). Currently, German clinics offer a variety of modern radiotherapy technologies that can effectively and safely irradiate the sensitive tissues of this area. Despite all the technical advances, radiotherapy plays a secondary role.

Radiation therapy before surgery (neoadjuvatory radiotherapy) is performed rarely.

This approach increases the chances of success of the surgery and is usually combined with chemotherapy (chemoradiation therapy).



Even if a tumor cannot be removed for medical or other reasons, radiotherapy is combined with chemotherapy or targeted therapy with monoclonal antibodies. Both methods can be used simultaneously or sequentially.

Systemic chemotherapy (starting $ 3000)

Cytotoxic drugs used in systemic chemotherapy spread throughout the body and affect cancer cells that have already spread through the blood vessels or lymphatic vessels far from the actual tumor site. Cytotoxic agents block cell division. Since cancer cells divide very quickly, they are very sensitive to cytostatics. However, chemotherapy almost always affects healthy cells.

Cells of the oral mucosa, intestinal mucosal cells, bone marrow blood cells and hair follicle cells are mainly affected. Side effects such as painful inflammation and ulceration of the oral mucosa, hair loss and leukopenia are common.

For head and neck tumors that cannot be removed surgically, chemotherapy is usually combined with radiation therapy (chemoradiation therapy). German oncologists often prescribe chemotherapy such as cisplatin or carboplatin, 5-FU (5-fluorouracil) and / or taxanes.

Chemotherapy without other methods of treatment is used only for cancer recurrence or metastases.

Platinum cytostatics (cisplatin and carboplatin), 5-fluorouracil, and taxanes are considered to be among the most effective agents for head and neck cancer. Other drugs such as gemcitabine, vinorelbine and methotrexate can also be used. In many cases, it is possible to achieve a better tumor response to treatment with a combination of cytostatic agents with different mechanisms of action.

New targeted therapy with cetuximab

Unlike chemotherapeutic agents, targeted drugs specifically inhibit signaling pathways in cancer cells. There are antibodies that need to be given as an infusion, as well as other substances that are often available in the form of tablets.

For the head and neck cancer treatment in Germany, an innovative drug cetuximab is used. This monoclonal antibody can complement chemotherapy and radiation therapy.

Cetuximab targets the binding sites (receptors) of the so-called epidermal growth factor EGF. Since EGF stimulates the growth of tumor cells, cetuximab interrupts this pathway and stops the growth of tumors.

Targeted therapy significantly increases sensitivity to radiotherapy and chemotherapy. In clinical trials, combination treatment with cetuximab plus radiation therapy or chemotherapy significantly prolonged patient survival compared to radiation therapy or chemotherapy alone.

Other targeted drugs are currently being studied in clinical trials.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator