According to official statistics from the WHO in 2022, oncological diseases are now the cause of one in every six deaths worldwide. This has encouraged the international medical community to develop new cancer treatment methods and increase the effectiveness of the already existing ones. This is particularly important for patients with advanced stages of the disease, where due to the tumour metastasis, almost the entire body is affected.
In 2018 the Study of the Immune System in Patients with Malignancies was awarded the Nobel Prize in Medicine. The activation of a patient's own immunity and the training of his immune cells to recognise the tumour is the basis of safe therapy for healthy tissues. This can be used even in advanced stages of the disease. It is possible in customised treatment, to adapt to the characteristics of the disease’s progression in a particular patient.
Table of contents:
- Principles of cancer treatment in classical medicine
- Disadvantages and limitations of classical cancer therapy
- Principles of cancer treatment using immunological techniques (immunotherapy)
- Therapeutic hyperthermia
- Infusion therapy to activate the immune system
- Chemoembolization in cancer treatment
- Treatment of advanced cancers in the specialized German clinics
- Indications for the comprehensive therapy in stage 4 cancer
- Organisation of treatment in Germany for international patients
Principles of Cancer Treatment in Classical Medicine
Classical medicine offers a number of possibilities in the treatment of cancer, which can affect a malignant neoplasm directly or through a modification of the tumour’s microenvironment:
- Surgical treatment includes a total or partial tumour removal, as well as tissue sampling for a histological examination. At the advanced stages of cancer these operations are rare. It is impossible to completely remove all metastases of a large tumour that has sprouted into adjacent organs.
- Radiation therapy is performed to reduce the malignant neoplasm in size or prevent relapse after surgery. Modern hospitals also provide stereotactic radiation therapy using the Gamma Knife or the CyberKnife systems. This is a targeted tumour removal that does not require a surgical intervention. The directed beam of ionizing radiation reaches the tumour through intact skin.
- Chemotherapy includes the prescription of drugs, which block the reproduction of cancer cells. Unfortunately, chemotherapeutic drugs also affect healthy tissues.
- Symptomatic treatment includes anaesthetic therapy; antiemetic drugs rich in proteins or parenteral nutrition. The symptomatic treatment does not eliminate the cause of the disease but improves the patient's quality of life to a certain point.
Depending on both the tumour type and the stage of the process, these 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 Medicine Cancer Therapy
Despite the extensive arsenal of classical techniques available and the vast practical experience of their use, the classical approach to cancer treatment has several limitations. These include:
- Injury – to ensure surgical access to a tumour, the healthy tissues are inevitably destroyed. This 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 cells. Also, during chemotherapy the bloodstream has the toxic decomposition products of the tumour, which causes damage to the liver and kidneys.
- The impossibility of a complete recovery– at stage IV cancer a limited range of treatment methods are applied. All of these methods aim to suppress tumour growth and prolong life but do not cure the patient.
- Suppression of the 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 are developing 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 the body's own defences, the immune system and nonspecific antitumour mechanisms. The therapy provides a long-term result and the complete elimination of cancer cells. In classical medicine the tumour and its metastases are removed artificially. However, alternative methods activate an "internal protection", which reveals metastases and groups of atypical cells, which may not be detected by even the most accurate medical equipment.
The conception of integrative medicine is characterised by the following aspects:
- Good tolerability, minimal side effects
- Targeted influence on tumour foci without affecting healthy tissues
- The possibility of use in patients with critical conditions (for example, with a decreased kidney or liver function or allergies)
- Achievement of a good result even at advanced stages of cancer with metastasis to body areas at a distance from the primary tumour
- Activation of patient’s antitumour immunity, restoration of T and B cells’ ability to detect and destroy abnormal tumour cells
- Permanent results without the need for constantly repeated treatment courses
In leading European Cancer Centres, 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 tumour part) and complements these 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 capillary networks do not have enough time to be formed in fast-growing malignancies. Therefore, with a temperature increase their blood flow decreases to almost zero. Without an adequate blood supply, the tumour and metastases do not receive the necessary nutrients and are quickly destroyed by the influence of their own toxic metabolic products. During this procedure the periods of the 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). This procedure is performed using specialised equipment– the Nd: YAG-laser, which consists of neodymium-doped yttrium aluminium garnet crystal. With the help of a miniature fibreglass applicator, the doctor delivers laser radiation directly to the tumour. During the treatment, the temperature in the target area reaches between 60-110°C, which leads to the tumour’s destruction.
LITT procedure is successfully used in inoperable tumours of the liver, kidneys, lungs, breast, prostate and other organs. LITT also allows 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.
The average cost of a comprehensive treatment program that includes hyperthermia and infusion therapy, which we will discuss below, is 18,000 euros.
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 tumour. The high selectivity of RNA in the composition of the drug, allows it to act precisely on the organs affected by cancer.
- Artesunate is a natural medication, the creation of which was awarded the Nobel Prize in 2015. The drug destroys cancer cells and blood vessels feeding the tumour.
- Curcumin is a natural plant pigment that causes tumour cell apoptosis and inhibits tumour metastasis. The reports of clinical investigations 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. These are the cells of the immune system responsible for recognising and destroying atypical cancer cells.
- Hypericin is a red, vegetable pigment with the properties of an effective natural photosensitiser. 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, other rare and specialised methods may also be used. The average cost of a comprehensive treatment program that includes hyperthermia and infusion therapy is 18,000 euros.
Chemoembolization in Cancer Treatment
Transarterial chemoembolization (TACE) has a local effect on the tumour, using high dosages of chemotherapy drugs. Embolization is successfully used in the treatment of tumours with active blood supply, for example; liver cancer, breast cancer, colorectal tumours. 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 chemotherapeutic agents 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.
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 results 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 is removed and the femoral artery is covered with a pressure bandage for 3 hours. During the first few hours the patient should stay in the bed, after which he can return to his usual 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.
The cost of chemoembolization depends mainly on the level of the hospital where you are being treated and the type of cancer. For example, it is easier to perform chemoembolization for liver metastases than for adrenal metastases. The average cost of chemoembolization is 24,000 euros.
Treatment of Advanced Cancers in the Specialised German Clinics
Only a limited number of specialised Cancer Centers can offer patients with stage IV cancer the 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 Paediatric 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 chemoembolisation by Prof. Dr. med. T. Vogel (Head of the Department of Adult and Paediatric 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 five days
- Consultation with Prof. Vogel, TACE procedure planning
- Follow-up MRI and determination of chemoembolization scope
- TACE procedure (up to twenty-five minutes per area)
- Inpatient monitoring for three hours, follow-up CT scan
- Repeated examination by Prof. Vogel, after which the patient can leave the clinic
- After one day of recovery, the TACE procedure will be repeated in another area (if necessary)
On average, it is recommended to carry out three courses of embolization, with an interval of four-five weeks. The treatment regimen adapts as necessary to the clinical state of the patient and is adjusted in accordance with any changes.
Indications for the Comprehensive Therapy in Stage 4 Cancer
This approach has proven it efficacy in the treatment of the following diseases:
- Bowel cancer
- Rectal cancer
- Pancreatic cancer
- Breast cancer
- Lung cancer
- Stomach cancer
- Uterine cancer
- Ovarian cancer
- Thyroid cancer
In terms of prognosis, in most cases stage 4 cancer cannot be cured completely. However, the combination of conventional treatments with immunotherapy and other alternative methods can add months to a patient's life.
Remissions can last for years in some patients, as it has already been seen in colorectal, breast and prostate cancer. Based on the results of clinical trials in 2022-2023, doctors are cautiously talking about long-term remissions, which may well turn out to be a cure.
In German clinics, doctors carry out a thorough examination to assess a patient's prognosis and offer all possible treatments. Here, people with stage 4 cancer are not considered "incurable" or "terminal".
The Organization of Treatment in Germany for International Patients
Both citizens of the country and international patients can undergo the comprehensive treatment of stage IV cancer in Germany. If you are seeking medical care from a foreign clinic for the first time, it will be safer and more effective to charge with the organization of treatment. Booking Health is a medical tourism operator which helps patients from seventy-five different countries undergo treatment abroad.
With due consideration and all of the subtleties of care for patients with stage IV cancer, the Booking Health experts will help you with all the important issues:
- Confirmation of appropriate choice of clinic and direct communication with the attending physician
- Preliminary preparation of the treatment program, without repeating previous examinations
- Provision of a favourable 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 with buying and forwarding medicines
- Communication with the clinic after treatment completion
- Monitoring of invoices and return of any unspent funds
- Organization of any additional examinations
- Top-class service for booking hotels, airline tickets, transfers, 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 of the medical details and help you correctly prepare for the flight and treatment.
Choose treatment abroad and you will be sure to get the best results!
This article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko. 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!