©CC0/kalhh

More than 2 million people worldwide die of lung cancer per year. Therefore, this form of cancer ranks a sad leading position in comparison with other forms of cancer. Here is a brief insight into the medical work practice in Germany.

What is a bronchial carcinoma?

Lung cancer is also called bronchial carcinoma as the cancer cells usually develop from cells of the lower respiratory passages (bronchial tubes). The faster they divide and destroy the healthy tissue by growing, the more severe is the disease.

Stage of the disease

There are four different stages. The survival rate in stage 1 is the highest whereas it is the lowest in stage 4.

Stage 1: Localized tumour without lymph node involvement and without remote metastases
Stage 2 and 3: Tumour with larger spread and/or lymph node involvement
Stage 4: Tumour with larger spread and remote metastases

Type of tumour

Apart from the stage of the disease, the size of the tumour is another important characteristic in order to be able to assess the severity of the disease. Most people with lung cancer suffer from non-small cell lung carcinoma. These tumour cells grow slowly and also build metastases more slowly. That is why doctors can surgically remove non-small cell lung carcinoma if the disease has been diagnosed at an early stage.
If, by contrast, a small-cell lung carcinoma affects the lungs, the chance of survival diminishes. This is due to the fact that small cell lung cancer grows quickly and builds metastases in other organs at an early stage.

Causes of lung cancer

The main cause of lung cancer is considered to be smoking. The following applies: the longer someone has smoked, the higher the possibility that he or she will be diagnosed with cancer. Passive smoking increases the risk of cancer additionally. In Germany, the number of women with lung cancer increases while the number of diagnosed men stagnates. In an interview, Prof. Dr. Herth explains this development with the emancipation of women, which started in the 1960s. For many women, smoking was a symbol of independence. The consequences of the increased nicotine consumption only become apparent decades later.

Asbestos is carcinogenic. That is why it is prohibited in Germany as building material and is removed from existing substance. ©CC0/Armin Kübelbeck

Furthermore, pollutants in the workplace can promote a disease. The working material asbestos, which is used as insulating material, is particularly harmful. Hereditary predispositions can also play a role. The risk can increase if one parent had lung cancer. However, the relevance of these genetic influences is not proven.

Symptoms: Cough, bone pain and fever episodes

There are few typical signs of lung cancer. Therefore, smaller tumours are often discovered by chance when the lungs are x-rayed for other reasons, for instance when the affected person visits a doctor due to respiratory distress or shortness of breath.

Some symptoms for lung cancer:

  • Cough that lasts longer than three weeks
  • Long-lasting fatigue or exhaustion
  • Fever episodes
  • Hoarseness and difficulty swallowing
  • Bone pain
  • Swelling of lymph nodes above the collarbone
  • Significant weight loss
  • Coughing up small amounts of blood

If the patient suffers from any of the symptoms mentioned above, the doctor in Germany carries out various examinations in order to determinate the causes of the complaints. He usually starts with the imaging examination. With an x-ray of the lung, he tries to determine whether tumours have affected the lung.
Additionally, computer tomography (CT) can indicate the exact location and the local spread of the tumour. CT can also be used to search for tumour metastases in the head, chest and abdomen.

During a bronchoscopy, a flexible tube is passed through the patient’s mouth.
©CC0/National Cancer Institute

Another very important diagnostic measure when lung cancer is suspected is the endoscopy of the lung (bronchoscopy). The doctor inserts a flexible tube through the patient’s mouth and into the bronchi. At the end of the tube there is a small camera and forceps which are used to take tissue samples. These tissue samples are then examined. This enables the doctor to determine whether the sample material contains cancer cells.

Further measures: the doctor can detect metastases in the abdominal region using an ultrasound examination (sonography). The liver is especially prone to be affected. During bone or skeletal scintigraphy, a radioactive substance is injected into the bloodstream. Using a special camera, doctors can then determine bone metastases.

Therapy: surgery or chemotherapy?

Doctors in Germany are trying to treat lung cancer with various therapies. Which treatment approaches are being implemented depends on the patient’s health status and the severity of the bronchial carcinoma. Most people with lung cancer suffer from the less aggressive non-small cell bronchial carcinoma.
Especially if this form of lung cancer has not spread yet, which means that it is still in the first or second stage of disease, a surgery can make the complete healing possible.

The situation is different when remote metastases have already formed. Then, the primary aim of the treatment is to alleviate the complaints and to maintain the patient’s quality of life. The doctor prescribes chemo- and radiation therapies to comprehensively fight cancer cells. However, sometimes patients with a good chance of healing are recommended a chemotherapy or a combination of radiotherapy and chemotherapy. By this means, the tumour becomes smaller and the surgeon can remove it more easily during surgery.

Costs of treating lung cancer in Germany

The prices for the treatment of lung cancer depend on the type of surgical measures that are implemented. The diagnostic tests carried out and where post treatment takes place also influences price formation. Researchers of the Hemholtz Centre in Munich calculated that the treatment of a lung cancer patient in Germany costs 20,000€ on average. According to this calculation, the highest costs accrue in the first six months after the diagnosis because the patients get inpatient treatment during this period of time.

How expensive is the treatment of lung cancer in hospital?

Only considering the surgical procedure in hospital excluding follow-up care and care prior to the treatment, a patient pays 1,850€ on average for a hospital stay of 5 days. Special requests like a single room or a treatment by the head physician are not considered in this price calculation. However, in many hospitals these services can be booked in addition. Also, for patients from abroad, a fee is often charged for the longer consulting time. Doctors in Germany are legally required to clearly explain their proceedings to the patients. Therefore, they put emphasis on an adequate translation of their explanations, even if this may take up more time.

Not all examinations need to be done in a hospital. Registered doctors also often have the necessary equipment at hand. While the hospital charges according to the DRG flat rate catalogue, registered doctors refer to the German Scale of Medical fees for their invoicing. In this scale of fees, all prices for medical services are listed.

Costs for various diagnostic methods (practice)

In addition to the costs for the diagnostic methods, fees for counselling and medication accrue. Again, the following applies: treatment prices are individually different. Nevertheless, such price tables provide a higher degree of transparency if you want to compare costs of medical services in different countries. Thus, thanks to these price tables it becomes evident that an outpatient pulmonary pleura surgery is significantly more expensive in the USA than in Germany.