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 clinics in Germany, Israel, Switzerland, Turkey and other countries admit foreign patients with virtually no restrictions.
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 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 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 IV 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.
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.
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.
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.
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).
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. The company employs qualified doctors and medical coordinators.
The Booking Health specialists will help you:
- Select the right clinic with specialization in oncology and gastroenterology
- Establish direct communication with your attending physician
- Familiarize yourself with a preliminary diagnostic or therapeutic program
- 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 clinic upon treatment completion, organize additional diagnostic procedures and distance consultations
- Control the final calculation
- Book accommodation, airline tickets, transfer
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova