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According to official statistics of the WHO in 2018, oncological pathology became the cause of every 6th death worldwide. It encourages the international medical community to develop new cancer treatment methods and increase the effectiveness of the existing ones. In particular, it is important for patients with advanced stages of the disease, when due to the tumor metastasis almost the entire body is affected.
So, in 2018, the study of the immune system in patients with malignancies was awarded by the Nobel Prize in Medicine. The activation of patient's own immunity and training his immune cells to recognize the tumor is the basis of safe therapy for healthy tissues, which can be used even at the advanced stages of the disease. It is possible in the customized treatment adapted to the characteristics of the disease progression in a particular patient.
The article was written in collaboration with the specialists of the Helios Hospital Berlin-Buch. The Helios Hospital Berlin-Buch ranks among the TOP German hospitals and is certified by the German Cancer Society.
Principles of cancer treatment in classical medicine
Classical medicine offers a number of possibilities, which affect a malignant neoplasm directly or through a modification of the tumor microenvironment:
- Surgical treatment includes a total or partial tumor removal, as well as tissue sampling for a histological examination. At the advanced stages of cancer, the operations are rare, since it is impossible to completely remove all metastases and a large tumor, which has sprouted into adjacent organs.
- Radiation therapy is performed in order to reduce the malignant neoplasm in size or prevent relapse after surgery. The modern hospitals also provide stereotactic radiation therapy using the Gamma Knife or the CyberKnife systems. It is a targeted tumor removal, which does not require a surgical intervention. The directed beam of ionizing radiation reaches the tumor through the intact skin.
- Chemotherapy includes the prescription of drugs, which block the reproduction of cancer cells. Unfortunately, the chemotherapeutic drugs also affect healthy tissues.
- Symptomatic treatment includes anesthetic therapy, antiemetic drugs, rich in proteins or parenteral nutrition. The symptomatic treatment does not eliminate the cause of the disease, but improves patient’s quality of life to a certain limit.
Depending on the tumor type and the stage of the process, the methods can be used in monotherapy or in combination (for example, radiation therapy is complemented by symptomatic treatment, surgery is followed by chemotherapy, etc.).
Disadvantages and limitations of classical cancer therapy
Despite the extensive arsenal of classical techniques and long practical experience of their use, the classical approach to cancer treatment has several limitations. These include:
- Injury – to ensure the surgical access to a tumor, the healthy tissues are inevitably destroyed. It is dangerous because the regeneration processes in cancer patients are weak, such patients are prone to infections.
- Toxicity – chemotherapy drugs inhibit the basic processes of cellular metabolism by destroying not only cancer cells, but also healthy ones. Also, during chemotherapy, the bloodstream has the toxic decomposition products of the tumor, which cause damage to the liver and kidneys.
- The impossibility of complete recovery – at the stage IV cancer a limited range of treatment methods is applied. All of them aim to suppress tumor growth and prolong life, but not to cure.
- Suppression of patient's immune system – T-cell and B-cell immunity are inhibited.
- High cost – often, chemotherapy is carried out for several months or even years. For a patient who pays for the treatment himself, it becomes quite expensive. Surgical interventions, especially brain surgeries are also costly.
Considering the results of classical oncopathology treatment regimens, scientists develop new, more effective and less traumatic therapeutic approaches for the body.
Principles of cancer treatment using immunological techniques (immunotherapy)
The main principle of this treatment is the restoration of body's own defenses, the immune system and nonspecific antitumor mechanisms. It provides a long-term result of therapy and the complete elimination of cancer cells. In classical medicine, the tumor and its metastases are removed artificially, while alternative methods activate the "internal protection", which reveals metastases and groups of atypical cells that may not be detected by the most accurate medical equipment.
The conception of integrative medicine is characterized by the following aspects:
- Good tolerability, minimal side effects
- Targeted influence on tumor foci without affecting healthy tissues
- The possibility of use in patients with critical condition (for example, with a decreased kidney or liver function, allergies)
- Achievement of a good result even at the advanced stages of cancer, with metastasis to distant body areas from the primary tumor
- Activation of patient’s antitumor immunity, restoration of the ability of T and B cells to detect and destroy abnormal tumor cells
- Permanent result without the need for constant repeated treatment courses
In leading European Cancer Centers, the doctors practice an integrated approach for the treatment of advanced cancer. The integrative approach includes potentially useful classical medical methods for the patient (for example, surgical removal of a tumor part) and complements them with alternative methods. It is a proven fact that the individual concept of comprehensive treatment gives the best clinical outcome.
Hyperthermia is the heating of a body part, an anatomical area, or the whole body to an effective temperature of 38-42 °C. The normal vessels and the capillary network do not have enough time to be formed in the fast growing malignancies, therefore, in the case of temperature increase, their blood flow decreases to almost zero. Without an adequate blood supply, the tumor and metastases do not receive the necessary nutrients and are quickly destroyed by the influence of their own toxic metabolic products. During the procedure, the periods of body heating and cooling alternate, so it is well tolerated by patients.
One of the innovative types of thermotherapy is laser-induced interstitial thermotherapy (LITT). The procedure is performed using specialized equipment – Nd:YAG-laser, which consists of neodymium-doped yttrium aluminum garnet crystal. With the help of a miniature fiberglass applicator, the doctor delivers laser radiation directly to the tumor. During the treatment, the temperature in the target area reaches 60-110°C, which leads to the tumor destruction.
LITT procedure is successfully used in inoperable tumors of the liver, kidneys, lungs, breast, prostate and other organs. LITT also allows the doctors to carefully destroy metastases in parenchymal organs and lymph nodes. This procedure is the treatment of choice in patients with metastases in the liver and lungs who may not survive after surgery.
Infusion therapy to activate the immune system
Infusion therapy includes the introduction of a number of substances:
- Regeneresen is a group of injectable drugs that restore the protein biosynthesis disturbed by the formation of a tumor. The high selectivity of RNA in the composition of the drug allows it to act precisely on the organs affected by cancer.
- Artesunat is a natural medication based on the component of wormwood (artemisinin), the creation of which was awarded with the Nobel Prize in 2015. The drug destroys cancer cells and blood vessels feeding the tumor.
- Curcumin is a natural plant pigment that causes tumor cell apoptosis and inhibits tumor metastasis. The reports of clinical trials of curcumin in cancer treatment were published in Clinical Gastroenterology Hepatology and Molecules journals, as well as on the Australian Science Network website.
- GcMAF is a modified human protein involved in the activation of macrophages, which are the cells of the immune system responsible for recognizing and destroying atypical cancer cells.
- Hypericin is a red vegetable pigment with the properties of an effective natural photosensitizer. Hypericin is used in photodynamic cancer therapy, which implies the destruction of pretreated atypical cells using laser radiation.
Depending on the type of malignancy and the results of histological diagnostics, there may also be used other, more rare and specialized methods.
Chemoembolization in cancer treatment
Transarterial chemoembolization (TACE) is a local effect on the tumor with high dosages of chemotherapy drugs. Embolization is successfully used in the treatment of tumors with active blood supply, for example, liver cancer or breast cancer, colorectal tumors. Unlike classical systemic chemotherapy, chemoembolization:
- Has a targeted effect on the tumor and is less toxic to the surrounding healthy tissues.
- Provides a higher concentration of chemotherapy drug in the target area.
- Has a longer effect, because blood flow through the arteries is blocked, as a result of which medications cannot enter the systemic circulation.
- Stimulates tumor necrosis and destruction by blocking the blood supply and depriving the tumor of the necessary nutrients for vital activities.
Due to its excellent tolerability, TACE is performed on an outpatient basis and requires only a short inpatient stay. At the preparation stage, doctors conduct angiography, which is a contrast radiography allowing for a precise imaging of the tumor vessels. The leading cancer clinics use only angiography devices with high image accuracy, since it is important to identify all sources of blood supply. Also, CT, MRI and PET-CT data are taken into account.
During the procedure, a thin catheter is inserted into the femoral artery, which moves through the blood vessels and reaches the target area (for example, the hepatic artery). The next step is chemotherapy drug injection into the tumor. The artery is "blocked" with an embolus. There may also be used drug-coated microspheres (DEM), for example, LifePearl or HepaSphere microspheres.
Once TACE is completed, the catheter will be removed and the femoral artery will be covered with a pressure bandage for 3 hours. The first few hours the patient should observe bed rest, after which he can return to his normal life. The next day after the intervention, the patient should have a follow-up CT scan to evaluate the effectiveness of treatment. If necessary, TACE will be repeated several times to completely block the smallest tumor vessels.
Treatment of advanced cancers in the specialized European clinics
Only a limited number of specialized Cancer Centers can offer patients with stage 4 cancer medical equipment and the services of qualified specialists for alternative therapy. The most significant results in this area are demonstrated by the Clinic of Advanced Biological Medicine in Frankfurt am Main and its Head, Dr. med. Gerhard Siebenhüner. Also, the Department of Adult and Pediatric Diagnostic, Interventional Radiology at the University Hospital Frankfurt am Main leads the LITT and TACE areas.
The effective comprehensive treatment for advanced cancer consists of several stages. These include immunotherapy by Dr. G. Siebenhüner and transarterial chemoembolization by Prof. Dr. med. T. Vogel (Head of the Department of Adult and Pediatric Diagnostic, Interventional Radiology at the University Hospital Frankfurt am Main). To ensure the best possible effectiveness, the therapeutic methods are applied in the following sequence:
- Consultation and immunotherapy by Dr. G. Siebenhüner, the course lasts 5 days
- Consultation with Prof. Vogel, TACE procedure planning
- Follow-up MRI and determination of chemoembolization scope
- TACE procedure (up to 25 minutes per area)
- Inpatient monitoring during 3 hours, follow-up CT scan
- Repeated examination by Prof. Vogel, after which the patient can leave the clinic
- After 1 day recovery, the TACE procedure will be repeated in another area (if necessary)
On average, it is recommended to carry out 3 courses of embolization with an interval of 4-5 weeks. The treatment regimen necessarily adapts to the clinical state of the patient and is adjusted in accordance with its changes.
Indications for the comprehensive therapy in stage 4 cancer
This approach has proven itself in the following diseases:
- Bowel cancer
- Rectal cancer
- Pancreatic cancer
- Breast cancer
- Lung cancer
- Stomach cancer
- Uterine cancer
- Ovarian cancer
- Thyroid cancer
Organization of treatment abroad for international patients
Both citizens of the country and international patients can undergo the comprehensive treatment of stage 4 cancer in Germany. If you are seeking for medical care from a foreign clinic for the first time, it will be safer and more effective to charge Booking Health with the organization of treatment. Booking Health is a certified medical tourism operator, which helps patients from 75 countries to undergo treatment abroad.
With due consideration of all the subtleties of care for patients with stage 4 cancer, the Booking Health experts will help you with such important issues:
- Confirmation of the correctness of the choice of the clinic and direct communication with the attending physician
- Preliminary preparation of the treatment program without repeating previous examinations
- Provision of a favorable cost of clinic services, without any extra charges and coefficients for foreign patients (saving up to 50%)
- Doctor’s appointment on the desired date
- Control of the medical program at all its stages
- Assistance in buying and forwarding medicines
- Communication with the clinic after treatment completion
- Monitoring of invoices and return of unspent funds
- Organization of additional examinations
- Top-class service for booking hotels, airline tickets, transfer, interpreting services
To get professional help in planning treatment abroad, leave your request on the official Booking Health website. A competent medical consultant will discuss with you all the medical details and help you correctly prepare for the flight for treatment.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova