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The treatment of stomach tumors in foreign medical institutions attracts patients from countries with underdeveloped medical systems due to the availability of innovative diagnostic and surgical equipment, as well as a wide range of drugs for chemotherapy, immunotherapy and targeted therapy. The hospitals in Germany, Israel, Switzerland, Turkey and other countries admit foreign patients with virtually no restrictions.
- Diagnostics: detailed imaging and molecular studies
- Surgical removal of gastrointestinal neoplasms
- Minimally invasive local treatments
- Systemic therapy and biological treatments
- Treatment for stage 4 stomach cancer
- Hospitals and cost of treatment
- Travel abroad for treatment with Booking Health
Diagnostics: detailed imaging and molecular studies
In addition to studies according to the standard protocol (tumor marker tests, ultrasound examination, gastroscopy, biopsy), the diagnostics of stomach cancer in the leading world’s clinics includes:
- Endoscopic ultrasound scan increases the diagnostic value of endoscopic examinations. A special endoscope with an ultrasound probe allows for examining the layers of the stomach wall and determining the depth of the tumor invasion in case of its endophytic growth. A targeted biopsy of the stomach wall and regional lymph nodes is also performed under the ultrasound guidance.
- High-resolution imaging studies, including CT, MRI and PET. CT is also used to control fine needle aspiration or core needle biopsy of small neoplasms (up to a centimeter).
- Molecular studies of tumor tissue with an assessment of the levels of HER2 tumor growth factor using the immunohistochemical analysis or fluorescence in situ hybridization (FISH).
- Diagnostic surgical procedures can be performed in complex clinical cases, when other studies do not allow oncologists and surgeons to determine the stage of stomach cancer reliably. The sparing laparoscopic surgery allows doctors to directly examine the external surface of the stomach, assess the condition of the peritoneum and lymph nodes. If necessary, the doctor rinses the peritoneal cavity with physiological saline, which allows for identifying atypical cells that are invisible to the naked eye.
The determination of the exact tumor location in the stomach wall, the detection of micrometastases and the preliminary assessment of the response of tumor cells to chemotherapy and biological agents allow oncologists to develop the optimal treatment regimen for a particular patient. At the same time, the doctors strive to minimize the side effects of therapy and alleviate the patient's symptoms, evaluating not only the life expectancy, but also its quality.
Surgical removal of gastrointestinal neoplasms
When treating stomach cancer abroad, surgery is the gold standard and can be performed even in incurable patients at stage 4 of the disease. The surgeons of the specialized clinics give preference to endoscopic interventions, which can reduce the trauma of healthy tissues and the risk of intra- and postoperative complications. At the same time, the specialists control the completeness of primary tumor removal ("cleanliness" of the edges of the surgical incision and the absence of metastases) and, if necessary, perform more extensive open operations.
The treatment of early stomach cancer (in situ or T1a tumors) includes endoscopic mucosal resection, while some cases may require an additional submucosal layer dissection. This means that the surgeon completely removes the superficially located malignant lesion endoscopically by introducing special tools through the pharynx and esophagus, without cutting the anterior abdominal wall and the stomach itself.
When the tumor grows into the muscle layer or adjacent organs, the surgeons perform a partial or total stomach resection. The total stomach removal is followed by the connection of the esophagus directly to the intestine or the formation of a small "stomach" from the upper part of the small intestine. This restores the passage of food, but does not allow to avoid a deficiency of hormones and vitamins, which are normally synthesized in the stomach. Therefore, after the operation, gastroenterologists and nutritionists develop a diet for the patient, select the necessary medicines and biological additives.
Also, with the preventive purpose, the surgeons can remove regional lymph nodes, which may contain microscopic metastases that are invisible during diagnostic studies. Additionally, intraoperative or subsequent irradiation can be performed.
Minimally invasive local treatments
Hyperthermic intraperitoneal chemotherapy (HIPEC) is also called "hot chemotherapy". This technique includes rinsing the abdominal cavity with the heated solution with chemotherapy drugs. HIPEC can be the final part of surgery at any stage of stomach cancer or the separate type of treatment.
In the first case, HIPEC is started once the surgeon removes all visible tumors and malignant lesions and serves as the additional anti-relapse measure. Chemotherapy drugs in the heated solution penetrate deep into the visceral peritoneum and destroy the remaining malignant cells. Thus, HIPEC is strictly recommended for patients with abdominal metastases of stomach cancer or peritoneal carcinomatosis.
In the second case, HIPEC is performed regardless of surgical intervention. Catheters are inserted into the abdominal cavity through small incisions and heated solution is pumped through them. Heated chemotherapeutic drugs stay in the abdomen for about 2 hours. This exposure time is enough to reach all the affected regions and suppress malignant cells. This type of HIPEC may be administered at any stage of stomach cancer.
Embolization and chemoembolization are endovascular methods that block blood vessels feeding the tumor or metastatic foci. The thin flexible catheter is inserted into the bloodstream and moved towards the target blood vessel. A doctor receives information about the current localization of the catheter with the help of X-ray examination or tomography.
Once the catheter reaches the target vessel, lipid emboli are injected through it (embolization); this may be preceded by the introduction of a high dose of chemotherapeutic agent (chemoembolization). Both endovascular treatments reduce volume of the primary tumor or metastatic foci and contribute to improving the overall survival. Embolization is indicated both to patients with small primary tumors and advanced stages of stomach cancer (e.g. in treatment for stage 4 stomach cancer aimed at separate metastases).
Systemic therapy and biological treatments
As a part of systemic therapy, patients receive tableted and injectable drugs that inhibit growth or destroy cancer cells remaining in the body. Clinical oncologists select the sequence of application and a combination of techniques for each patient. This allows for enhancing the therapeutic effect of treatment and mitigating unwanted side effects, which is especially important during the treatment for stage 4 stomach cancer.
Chemotherapy in Germany is carried out in adjuvant or perioperative (within 8-9 weeks before and after the surgery) mode. The most effective regimens for perioperative chemotherapeutic agents are CF, ECF and FLOT. Adjuvant chemotherapy begins 4-6 weeks after surgery and is carried out according to XELOX (CAPOX) regimens.
As it was described above, chemotherapy can also be a local treatment, being administered during chemoembolization or HIPEC. When planning stage 4 stomach cancer chemotherapy, physicians choose combinations of 2 or 3 medications. Combinations of 2 drugs tend to have less side effects compared to combinations of 3 drugs, while the efficacy may be the same. Schemes FOLFOX, CAPOX, and FOLFIRI are used for stage 4 stomach cancer chemotherapy.
According to the information from randomized clinical trials, combination of few stage 4 stomach cancer treatment options enhances efficacy of each of them. Thus, chemotherapy is often given along with targeted therapy at advanced stages of stomach cancer.
Targeted therapy for stomach tumors affects two targets – human epidermal growth factor receptor 2 (HER2) and vascular endothelial growth factor (VEGF). With HER2-positive tumor status, patients receive trastuzumab (Herceptin), whereas with tumors with active growth and metastasizing ramucirumab (Cyramza) is prescribed.
Herceptin is administered in combination with fluoropyrimidine and cisplatin. The pivotal clinical trial has demonstrated that this therapeutic regimen improves survival of patients with HER-positive tumors, at the advanced stages of stomach cancer. Patients with higher levels of HER2 received the most benefit.
Treatment for stage 4 stomach cancer that includes Cyramza improves the average overall survival even in patients who have not responded to any therapy. Scheduling visits to hospital for Cyramza injections is the reasonable cost of treatment for cancer stage 4.
Immunotherapy is also planned based on the molecular genetic characteristics of the tumor. Should microsatellite instability (MSI-H) or high levels of PD-L1 be detected in the neoplasms, patients will receive pembrolizumab (Keytruda). According to the information from clinical trials, nivolumab (Opdivo) is another PD-1 inhibitor that is indicated to eligible patients with advanced stages of stomach cancer.
Treatment for stage 4 stomach cancer
Treating stage 4 stomach cancer is a challenging task. However, doctors have a number of options to choose from. To summarize up, stage 4 stomach cancer treatment options include:
- Surgery – removing the tumor and its metastases (open, endoscopic or robotic), which includes interventions on stomach, intectine, pancreas, etc.
- Minor surgical procedures – placing a gastrostomy tube or a jejunostomy tube, restoring the patency of gastrointestinal tract blocked by a tumor.
- Chemotherapy, including hyperthermic intraperitoneal chemotherapy (HIPEC) and introduction of high doses of chemotherapeutic agents during chemoembolization.
- Targeted therapy, as the addition to chemotherapy or independent treatment.
- Immunotherapy that turns on a patient's own anticancer immune response.
- Radiation therapy, including the intensity modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3D-CRT).
- Taking part in clinical trials with experimental medications.
You can receive the comprehensive and updated information about the most beneficial treatment options and the cost of treatment for cancer stage 4 at the Booking Health website. It should be noted that there is no standard therapeutic scheme or cost of treatment for cancer stage 4 as each case has its own peculiarities.
Hospitals and cost of treatment
Medical programs for stomach cancer treatment require coordinated work of diagnostic departments, gastroenterologists, abdominal surgeons, oncologists and radiologists, general practitioners, etc. Precise diagnosis making with determining the correct stage of stomach cancer is the basis of further successful treatment. So, the first issue that is worth paying attention to while looking for a hospital is the rate of accurate diagnosis making.
Next, the healthcare facility must have equipment for high-technology interventions, access to innovative medications and practical experience of using those technologies and medications. For instance, usage of sparing stage 4 stomach cancer treatment options is often limited by absence of necessary equipment or qualified physicians.
University hospitals are multidisciplinary healthcare facilities that offer the whole range of diagnostic and therapeutic measures. Leading university hospitals that are ready to admit patient with any stage of stomach cancer and offer comprehensive stage 4 stomach cancer treatment:
- University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology
- University Hospital of Ludwig Maximilian University of Munich, Department of Gastroenterology and Hepatology
- University Hospital Ulm, Department of Gastroenterology and Hepatology
- University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
- University Hospital Heidelberg, Department of Gastroenterology, Hepatology and Infectology
Prices of medical programs may differ from hospital to hospital. The stage of stomach cancer, type of the intervention, patient’s age and presence of comorbidities influence the final treatment cost. It is also better to make sure that your insurance company covers all the expenses, especially in case of stage 4 stomach cancer treatment. The approximate prices are as follows:
- Diagnostics of stomach cancer – from €1,546
- Surgical treatment of stomach cancer with partial resection of the stomach and subsequent anastomosis formation, including the cost of treatment for stomach cancer stage 4 – from €20,469
- Surgical treatment of stomach cancer with complete resection and subsequent plasty of the intestinal tissue, including the cost of treatment for stomach cancer stage 4 – from €20,162
- Diagnosis and chemotherapy of stomach cancer (1 course), including the cost of treatment for stomach cancer stage 4 – from €2,168
- Multimodality treatment of stomach cancer with cytoreductive surgery and HIPEC, including the cost of treatment for stomach cancer stage 4 – from €38,211
- Treatment of stomach cancer with embolization or chemoembolization, including the cost of treatment for cancer stage 4 – from €23,740
- Rehabilitation after the completion of the main stomach cancer treatment course – from €951 per day
Travel abroad for treatment with Booking Health
The patients and their relatives can avoid the difficulty of choosing a foreign clinic and treatment options using the services of Booking Health. The employees of Booking Health specialize in all aspects of medical tourism and offer comprehensive help for patients with any stage of stomach cancer, including treatment for stage 4 stomach cancer. The company employs qualified doctors and medical coordinators.
The Booking Health specialists will help you:
- Select the right hospital with specialization in oncology and gastroenterology
- Select the right hospital with specialization in stage 4 stomach cancer treatment options
- Establish direct communication with your attending physician
- Familiarize yourself with a preliminary diagnostic or therapeutic program, including stage 4 stomach cancer treatment options
- Ensure a favorable cost of medical services, exclude overpricing and additional coefficients for foreign patients (saving up to 50%)
- Make an appointment on the desired date
- Additionally monitor all stages of the medical program
- Insurance against the cost of treatment increase in case of complications (а coverage of 200,000 EUR, valid for 4 years)
- Buy the right medicines and medical products
- Maintain contact with the hospital upon treatment completion, organize additional diagnostic procedures and distance consultations
- Control the final calculation
- Book accommodation, airline tickets, transfer
You can easily find all the necessary information regarding therapeutic options, including stage 4 stomach cancer treatment options, healthcare facilities and physicians on the Booking Health website. To receive the personal consultation, please, fill in the "Send request" form, and a medical advisor will contact you ASAP.
Choose treatment abroad and you will for sure get the best results!