Head and neck tumour centre

The Head and Neck Tumour Centre at Ulm University Hospital has been certified by the German Cancer Society since 2012 and is a supra-regional centre for the treatment of head and neck tumours in Germany. Almost 1000 patients with head and neck tumours are treated each year. Every week, 15-20 patients with tumours are discussed in the interdisciplinary conference. State-of-the-art treatment options are available in collaboration with the clinics and institutes for

• Ear, nose and throat medicine, head and neck surgery
• Oral and maxillofacial surgery
• Radiotherapy and radiooncology
• Diagnostic and interventional radiology
• Internal Medicine III, Haematology and Oncology
• Pathology
• Nuclear medicine
• Neurosurgery
• Psychosomatics, psycho-oncology consultation service

Close networking ensures that patients receive optimum treatment.

In the narrower sense, head and neck tumours are tumours of the pharynx (Latin: pharynx), larynx (Latin: larynx), lip and oral cavity that arise from the local mucous membrane, the squamous epithelium. Tumours of the salivary glands, tumours of the thyroid gland and tumours of the nose and paranasal sinuses are rarer and are often treated separately within head and neck tumours due to their different histories, tissue types and treatment.

The incidence of malignant tumours in the head and neck area is one of the ten most common malignant neoplasms in the global tumour rankings; in Germany, this corresponds to around 20-25,000 new cases per year, making it the fourth most common cancer. 4th most common cancer

Triggering factors include tobacco, alcohol or a combination of these, viral infections (HPV, EBV), harmful substances such as asbestos, wood dust (sinus tumours), UV and radioactive radiation, a weakened immune system, poor oral hygiene and chronic irritation.

The human papilloma virus (HPV) has been identified as a significant, newly-identified risk factor. It plays an important role in the development of tonsil cancer (oropharyngeal carcinoma) in particular. Younger patients without the typical risk profile (tobacco, alcohol) are particularly affected. In addition to traditional treatment methods (surgery, radiotherapy), vaccination strategies (similar to those for cervical cancer) are also being developed

Affected patients often consult a doctor at an advanced stage of the tumour, as tumours in the throat, for example, often only cause symptoms at a late stage. On the other hand, laryngeal tumours (especially vocal cord tumours) often attract attention due to the early onset of hoarseness.

The first symptoms of a head and neck tumour are quite varied:

• Difficulty swallowing
• Swelling of the throat
• hoarseness
• bad breath
• Bloody sputum
• shortness of breath
• One-sided obstructed nasal breathing in conjunction with nosebleeds
• Facial pain, visual changes and numbness

Examinations

The ENT medical examination includes, among other things, an orientating endoscopy of the upper airway with high-resolution optics (endoscopes).

Imaging:

• Ultrasound examination of the soft tissues of the neck and lymph nodes
• CT (computer tomogram): very good bone visualisation
• MRI (magnetic resonance imaging, magnetic resonance tomography): very good visualisation of soft tissue
• PET-CT (positron emission tomography CT) for "cancer of unknown origin" (CUP syndrome) or a recurrence situation (recurrence of a tumour). This makes it possible to visualise metabolic accumulation in the tissue as it occurs during tumour growth.

Endoscopy under general anaesthetic (panendoscopy)

If a tumour is suspected, a diagnostic panendoscopy of the upper respiratory and alimentary tracts is performed under general anaesthetic (2-day inpatient stay). This involves determining the extent of the tumour and taking a sample from the suspected tissue.

In order to determine the most suitable therapy, the size of the malignant tumour, the extent of local lymph nodes in the neck and the presence of distant metastases (lungs, liver) must be assessed before starting therapy.

Tumours are classified according to the international TNM classification criteria, with a general subdivision between stages I/II (localised) and III/IV (advanced) according to the World Health Organisation (WHO), as this has significant prognostic and therapeutic significance.

In principle, the extent of the treatment and the chances of success depend heavily on the stage of the disease. Small tumours in stage I, for example, have excellent chances of recovery. As the tumour stage increases, so does the treatment effort and the need to combine several treatment strategies.

Tumour conference

The various treatment options are discussed by an interdisciplinary team of experts (head and neck surgery, radiotherapy, oncology, pathology, radiology, nuclear medicine) together with the affected patients in a tumour conference before the start of treatment. After weighing up all the particularities, the patient is offered a highly individualised treatment recommendation based on the latest medical findings.

The tumour conference takes place on Mondays from 14:15-15:30 - patients and their relatives can attend.

For previously untreated patients with head and neck tumours, the focus is usually on surgical and radiotherapeutic treatment. In early tumour stages, the use of one form of therapy is often sufficient, whereas a combination is required for advanced forms of the disease. Chemotherapy or immunomodulating antibody therapy may be combined with radiotherapy in order to increase its effectiveness. They are used as a single treatment for very advanced and fully treated tumours (palliative situation).

Surgical tumour removal

Where possible, the tumour is removed in its entirety while maintaining a safety margin of approx. 5 mm. High-resolution surgical microscopes, endoscopes, laser procedures and high-precision techniques such as robotic surgery are used during tumour operations. Depending on the stage of the tumour, surgery is performed on one or both sides of the cervical lymph nodes ("filter station"). Depending on the extent of the tumour, a temporary tracheotomy may be necessary, which can often be closed again during the inpatient stay. Depending on the stage of the tumour, radiotherapy may be added to increase the chances of recovery.

Modern tumour surgery focuses on reconstruction and functional preservation in addition to the necessary radicality. The entire repertoire of plastic-reconstructive surgery is available for this purpose.

Radiotherapy

Depending on the extent of the findings, the state of health and the patient's wishes, a combination of radiotherapy and chemotherapy(simultaneous radiochemotherapy) or immunotherapy can usually be carried out as a non-surgical procedure. In order to reduce side effects, the total radiation dose (approx. 70 Gy) is not given in one day, but spread over 6-7 weeks. Typically, the therapy is carried out using state-of-the-art IMRT technology (intensity-modulated radiotherapy), which makes it possible to protect risk structures such as the salivary glands and the spinal cord with the same tumour effect.

Chemotherapy and immunotherapy

Classic chemotherapy is used either in combination with radiotherapy as an enhancer in the initial curative therapy. Platinum-containing substances such as cisplatin or carboplatin are often used here. Hair loss is not to be expected, and possible damage to the kidneys and hearing organs can be avoided through careful monitoring.

Immunotherapy is a relatively new approach and represents a major step towards individualised tumour therapy. This involves the use of antibodies against proteins on the tumour surface, such as the growth factor receptor (EGFR). This can delay tumour growth or, in combination with radiotherapy, stop it completely. Other very promising therapies against the so-called checkpoint inhibitors (e.g. PD-1, PD-L1) are being used in clinical trials.

Clinical trials

Wherever possible, tumour diseases are treated in clinical trials. Here, the best possible standard therapy is compared with new, even more superior therapies. Patients taking part in clinical trials are monitored even more carefully and closely by the responsible investigator and receive optimised treatment. The qualifiedstudy centre of the Head and Neck Tumour Centre is DIN EN ISO 9001 certified and integrated into the study centre of the CCCU.

Close tumour follow-up includes several aspects:

• Early detection of recurrence of the tumour and/or secondary tumours
• Monitoring and, if necessary, initiation of measures to improve organ function (e.g. voice and swallowing training)
• Assistance with reintegration into the social and professional environment
• Pain therapy
• Psycho-oncology

A thorough clinical examination is carried out at every follow-up examination.

In addition, imaging diagnostics (ultrasound, CT, MRI) are carried out regularly to rule out the possibility of a new tumour or metastases. In the event of unclear or suspicious findings, a sample is taken and, if necessary, an X-ray examination or an examination under anaesthetic is performed.

The intervals between follow-up appointments depend on the aggressiveness of the tumour, its location and its extent. Usually 1-3 month intervals are recommended for the first year, later 6-month intervals and from the fifth year annual intervals.

Tumour follow-up care is carried out in close cooperation with ENT specialists in private practice and - in addition to the other specialist disciplines involved in the treatment
(e.g. radiotherapists) - naturally also together with the family doctor.

The success of the treatment essentially depends on the location and stage of the tumour. Small circumscribed tumours of the larynx have the best prognosis. The presence or absence of metastases in cervical lymph nodes at the time of diagnosis is also an important prognostic factor. Through interdisciplinary therapy using the latest therapeutic principles, however, many tumours in advanced stages can also be cured or pushed back for years.

In addition to early detection of the tumour, prompt treatment is also crucial, which is guaranteed by optimised diagnostic and treatment procedures within the certified oncological head and neck centre.

The ENT Clinic is an integral part and driving force of the certified head and neck tumour centre and offers affected patients the highest quality of treatment and the latest techniques. This is achieved through the maximum commitment of its staff in the clinic, research and teaching, and is also made possible by the Excellence Initiative and funding from the Comprehensive Cancer Centre Ulm (CCCU) .

Appointments for initial assessment are available via the University Outpatient Clinic of the ENT University Clinic following referral by your ENT specialist or GP.

Tumour patients receive preferential appointments