Esophageal Cancer: Treatment in Germany

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Esophageal cancer is one of the twenty most widespread cancer types. The disease can develop at any age, but most often it is diagnosed over the age of 60, when treatment options are already somewhat limited by the patient's chronic conditions. Patients who undergo treatment in Germany have a chance to significantly increase their life expectancy through the use of sparing and effective methods. German specialists accurately assess the stage of cancer and the risks of various types of treatment, offering the patient the most suitable individual treatment regimen.

Content

1. How is esophageal cancer treated in Germany?
   • Surgical treatment
   • Radiation therapy and chemotherapy
   • Targeted therapy
   • Immunotherapy
2. Benefits of diagnosing esophageal cancer in Germany
3. Clinics that treat esophageal cancer
4. Arrangement of esophageal cancer treatment in Germany

How is esophageal cancer treated in Germany?

The success of the treatment of esophageal cancer directly depends on the timeliness of the disease detection, but this is not the only factor. In Germany, therapy is individually selected for each patient. It is developed with due consideration of a number of criteria:

• The stage of the oncological process, the presence of affected lymph nodes and distant metastases
• Tumor location – upper, middle, or lower third part of the esophagus
• Histological type of the tumor – squamous cell carcinoma or adenocarcinoma
• Primary tumor detection or recurrence after treatment
• Family history of esophageal cancer or other malignancies

Depending on the anamnesis and the results of the examination of the patient, the doctor chooses a treatment regimen, most often a combined one. If necessary, a tumor board is involved that includes a surgeon, oncologist, gastroenterologist and other necessary narrow specialists. Here are some of the treatments available in Germany:

• Surgical treatment
• Radiation therapy and chemotherapy
• Targeted therapy
• Immunotherapy

Surgical treatment

This treatment suggests the removal of a tumor and the adjacent tissues. The volume of the surgery depends on the stage of the oncological process and the type of the tumor growth (superficial or invasive, with affection of the muscular layer of the esophagus). In patients with superficial tumors, at the early stages of oncology, endoscopic interventions are performed in German clinics. Doctors insert an endoscope through the mouth and use it to perform a mucosal resection or endoscopic submucosal dissection. After such operations, a person quickly recovers and has no restrictions in the future.

Unfortunately, most cases of esophageal cancer are tumors that require open surgery or inoperable tumors. The reason for this is the late disease detection: it is most often diagnosed at stages 3-4. In this case, an open operation is performed with the removal of the tumor, neighboring lymph nodes and part of the stomach. German doctors pay special attention to the reconstructive stage of treatment: they use parts of the small intestine to rebuild the esophagus and ensure the normal movement of food through the gastrointestinal tract.

When radical treatment is not possible, palliative interventions are performed. They can improve the quality of life of the patient, but virtually do not affect the outcome of the disease. Usually, esophageal bougienage is performed with the installation of a stent. A stent is a tube that holds the shape of the esophagus and enables the patient to swallow food on his own.

Radiation therapy and chemotherapy

Radiation and systemic chemotherapy are used in combination. This is a neoadjuvant treatment before surgery or stand-alone treatments in unresectable cancer. They allow doctors to prolong a patient’s life for several months or years. Radiation therapy also helps to prepare the patient for surgery: after irradiation, the tumor shrinks, and it is easier for the surgeon to remove it.

In Germany, distant and contact radiation therapy (low and high dose brachytherapy) are used. In the first case, doctors can simultaneously target the tumor and neighboring lymph nodes. In the second they can irradiate small tumors or eliminate swelling of the mucous membrane, which hampers breathing and swallowing.

Chemotherapy is carried out in cycles lasting 2-3 weeks. Most medications are administered intravenously, but there are also oral medications. The total duration of chemotherapy is 3-6 months, depending on the response of the tumor to chemotherapy and the general condition of the patient.

Targeted therapy

Targeted therapy involves the use of drugs that suppress tumor growth and have virtually no toxic effects on healthy tissues. Action of this group of drugs is based on changes that are present only in malignant cells and are specific for esophageal tumors. Doctors may combine targeted therapy with systemic chemotherapy or give it to patients in whom chemotherapy no longer works.

Targeted therapy is mainly used for esophageal adenocarcinoma; such drugs for the treatment of squamous cell carcinoma have not yet been developed. In German hospitals, you can undergo treatment with several types of medicines:

• Drugs that affect HER2, a protein that is present in large quantities on the surface of cancer cells and stimulates their growth
• Antibody-drug conjugates affecting HER2
• Drugs that affect the VEGF receptor, a protein that stimulates the formation of new blood vessels to feed the tumor
• Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, a drug that affects cells with abnormal gene fusion

Targeted therapy is a relatively new direction in oncology, which is actively used in German hospitals and demonstrates good therapeutic results.

Immunotherapy

Immunotherapy is the first-line treatment in two cases:

1. If the patient has been diagnosed with advanced esophageal squamous cell carcinoma. Immunotherapy is carried out regardless of the PD-L1 status, it is combined with chemotherapy.
2. If an esophageal adenocarcinoma is rapidly progressing against the background of treatment, while PD-L1 is actively synthesized in the tumor cells.

PD-L1 is a component of the cell wall, a programmed death ligand. The action of most immunotherapeutic drugs is based on its activation. German oncologists also use immune checkpoint inhibitors. These drugs make it difficult for the tumor to disguise itself as healthy tissue and avoid attacks of the patient's immune system.

Benefits of diagnosing esophageal cancer in Germany

Both the diagnosis and treatment of esophageal cancer are more effective in Germany than in most other countries around the world.

The main benefits include: 

• An examination in precancerous conditions (in men and in women). Most patients develop esophageal cancer due to precancerous conditions. Among them are leukoplakia, ulcers and scars, papillomas and adenomas, diverticula, and esophageal achalasia. A periodic preventive examination of risk group patients enables a timely detection of esophageal cancer, until doctors can perform radical surgery to treat it. 
• High-precision cancer diagnostics. To diagnose oncological diseases, Germany uses highly sensitive diagnostic techniques. Therefore, esophageal cancer can be detected in any type of growth, even in the early stages. The country offers opportunities for preventive, non-invasive, and painless examinations of risk group patients. 
• Quality surgical treatment. If the cancer is detected at its early stages, Germany can provide minimally invasive treatment. To this end, specialists use endoscopic surgery. The further development of the tumor requires open surgery, which should be performed by experienced surgeons. The extent of the surgical intervention is planned in such a way as to minimize the risk of tumor recurrence.

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Clinics that treat esophageal cancer

In Germany, you can find a variety of clinics that provide esophageal cancer treatment. Most often, these are specialized departments of large university hospitals, where interdisciplinary tumor boards can take place. Here are some of them:

• University Hospital Frankfurt am Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
• University Hospital Heidelberg, Department of Gastroenterology, Hepatology and Infectology
• University Hospital Hamburg-Eppendorf, Department of Gastroenterology, Hepatology and Infectology
• University Hospital Würzburg, Department of Gastroenterology, Hematology, Oncology, Hepatology, Infectology, Rheumatology and Clinical Immunology
• University Hospital Bonn, Department of Gastroenterology, Hepatology, Nephrology, Infectology, Endocrinology and Diabetology

Depending on the stage of the disease and the patient’s general health condition, doctors can use one of the following directions of the disease therapy (average prices are mentioned):

1. Esophageal cancer treatment with endoscopic bougienage and stenting – 10,260 €
2. Esophageal cancer treatment with chemotherapy – 9,270 €
3. Esophageal cancer treatment with brachytherapy – 22,010 €
4. Esophageal cancer treatment with proton therapy – 78,020 €
5. Surgical treatment of esophageal cancer with resection and plasty using small bowel tissues – 45,460 €

After completing the main course of treatment, a follow-up period starts: every 6 months, a chest CT scan and endoscopic examination are performed. A good addition would be oncological rehabilitation – a set of procedures that will allow a patient to quickly return to normal life.

Arrangement of esophageal cancer treatment in Germany

Esophageal cancer progresses very quickly. In a matter of weeks, it can become inoperable, meaning even the German specialists will not be able to significantly prolong the patient’s life. Consequently, it is very important to start treatment as soon as possible. Nonetheless, the problem is that it is almost impossible to arrange an urgent trip to Germany on your own. You will have to wait a long time for a response from the chief physician, as well as collect, draw up, and translate documents, and then wait for a long time to see an oncologist. Therefore, you can contact Booking Health. We will make an urgent appointment for you with a doctor in one of the best oncological German hospitals.

By cooperating with us, you receive a number of additional benefits: 

• Choosing a hospital that specializes in the treatment of esophageal cancer
• Arranging a preliminary distant consultation with the attending physician, if necessary
• Arranging a tumor board
• Visa support
• Reducing medical costs by up to 50% due to the exclusion of taxes for foreign patients
• Insurance against unforeseen medical expenses
• Free doctor’s advice within the 3 months after your treatment program’s completion
• Services of an interpreter and personal coordinator, translation of medical documents
• Top-level service: booking hotels, plane tickets, transfers

We will contact you within 24 hours and help you receive urgent medical care in Germany. We work with cancer patients from 75 countries around the world and we know the specifics of the treatment organization in each case.

 

Send request for treatment

Choose treatment abroad and you will for sure get the best results!

 

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See the interview for more information:

INNOVATIVE TYPES OF RADIATION THERAPY FOR CANCER – interview with Dr. med. Peter Stoll

Authors:

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Nadezhda Ivanisova. 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:

National Center for Biotechnology

Cancer Research Institute

American Cancer Society

 

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