Treatment of stage 4 liver cancer in Germany | Booking Health

Treatment of stage 4 liver cancer in Germany

The article was reviewed by an expert in the field of medicine Prof. Dr. med. Thomas Vogl

If you need detailed information on methods and costs of treating earlier-stages liver cancer, you'll find it here.

Liver cancer usually develops between the ages of 50 and 65. It is less common than other malignant tumors. It ranks 5th in terms of incidence rates among men and 8th amongst women. In 75% of cases, the disease is detected at an advanced stage, when it is no longer localized. It is then usually treated with radical surgery. Nowadays, Germany is actively developing and applying more effective therapeutic methods, which allow doctors to achieve excellent results, even in patients at stage 4 of the pathology.


  1. Standard treatment methods for liver cancer and their disadvantages
  2. Innovative treatment methods for stage 4 liver cancer in Germany
  3. Benefits of stage 4 liver cancer treatment in Germany
  4. How to undergo treatment in Germany?

Standard treatment methods for liver cancer and their disadvantages


Stage 4 liver cancer can be diagnosed in cases where abnormal cells have spread to distant organs, or in cases of tumor invasion into other abdominal organs. Classic treatment at this stage involves radiation therapy, cryoablation, chemotherapy, and/or surgical removal of the neoplasm. 

However, chemotherapy and surgical removal of the neoplasm both have a number of disadvantages:

  • Surgical interventions are traumatic and require long-term recovery.
  • Chemotherapy drugs and radiation therapy negatively affect cells in the whole body, thereby reducing general immunity.
  • All methods are aimed at tumor growth cessation, but not at the treatment.
  • Standard methods are ineffective and do not always increase life expectancy.

It is worth noting that in many cases of stage 4 liver cancer, surgery is contraindicated. Moreover, cancer cells often have low sensitivity to chemotherapy. That is why more and more patients go for treatment in German hospitals, which can offer innovative treatment methods.

Innovative treatment methods for stage 4 liver cancer in Germany


German hospitals successfully use sparing treatment methods for malignant tumors, which do not require a thoracotomy. The most effective of these treatments are embolization, ablation, and immunotherapy.

Embolization of metastases


Embolization is a low-traumatic operation, the purpose of which is to block the blood vessels feeding the tumor. As a result, cancer cells stop receiving nutrients and die quickly. In Germany, two main types of embolization are commonly used for liver cancer: chemoembolization and radioembolization.

Transarterial chemoembolization is the most common procedure, combining two treatment methods: embolization and local chemotherapy. The use of this procedure for stage 4 liver cancer involves arterial lumen closure, using microspheres containing chemotherapy drugs. They are gradually released over several weeks, creating a high concentration of drugs in the hepatic parenchyma and inhibiting the growth of neoplasms. After the procedure, the primary tumor can drastically decrease in size, sometimes by tens of times. Unlike standard chemotherapy for the fourth stage liver cancer, the patient does not experience any side effects after chemoembolization.

This method has the following advantages:

  • Chemoembolization is effective not only for primary, but also for metastatic liver cancer (develops as a result of tumors in other organs). Metastatic liver cancer is the most common – it occurs 20-30 times more often than primary cancer. Tumors in the bowel, stomach, pancreas, ovaries, and other organs located outside the abdominal cavity, can spread to the liver. They can only be removed surgically in 15% of patients. In other cases, specialists use other treatment methods, including chemoembolization.
  • The treatment is safe, as the liver has a blood supply from two sources. The healthy parenchyma receives 70% of its blood supply from the portal vein and 30% from the hepatic artery. At the same time, a malignant tumor receives up to 95% of its blood from the hepatic artery. Therefore, its closure with emboli saturated with chemotherapy drugs, provides a targeted effect on the cancer cells. Although liver function can also decrease, the procedure does not lead to critical health consequences.
  • Previously, chemoembolization for the treatment of liver cancer was only carried out with preserved organ function, in order to avoid complications, but now, German hospitals use hepatoprotectors (drugs to protect the liver) as part of the newest medical advancements, which allows doctors to perform the procedure on patients with liver failure too.
  • Transarterial chemoembolization is absolutely safe and does not cause any complications. Uncomfortable sensations can occur during the first few days after the operation and they can be easily eliminated with the help of drugs.

The radioembolization technique differs from chemoembolization in that the microspheres are saturated not with drugs, but with radioactive substances. It has been used as a treatment option for inoperable liver cancer since 2016.



Ablation is the destruction of cancer tissue using various types of energy or chemicals (alcohol, acetic acid). The procedure is usually combined with chemoembolization and other treatment methods for liver cancer.

Until recently, the most popular procedure was radiofrequency ablation, which involved the insertion of a probe into the liver tissue, heating it up and therefore, leading to the destruction of the metastatic neoplasms. However, German hospitals increasingly use microwave ablation. This is a more progressive technique with several advantages. It appeared simultaneously with radiofrequency ablation, but could not be introduced into clinical practice for technical reasons. Rather, compact devices for microwave ablation appeared only a few years ago. They can be inserted into the tumor through a puncture in the abdomen. The essence of the technique is that an antenna, which emits electromagnetic energy, is used to heat the tumor. 

This method has the following advantages:

  • local use of high temperatures, without affecting the healthy tissues;
  • procedure is performed in just a few minutes;
  • neoplasms up to 8 cm can be destroyed;
  • microwaves can easily penetrate even charred or dehydrated areas;
  • microwave ablation destroys neoplasms at a distance of 1 cm from large blood vessels or bile ducts;
  • possibility of destroying several metastases simultaneously (by simultaneous use of several antennas).

In some German hospitals, doctors have begun using another type of ablation to destroy liver tumors, namely, high-intensity focused ultrasound (HIFU). Its advantage is that the method does not require a surgical intervention.


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Treatment of stage 4 liver cancer in Germany


Additional effects of embolization and ablation techniques


It is interesting that ablation and embolization of the hepatic artery leads to the elimination of not only the tumor in the liver, but also of its distant metastases. The fact is, that during the procedures, cancer cells die in large numbers. In this case, a large number of the so-called "danger signals" – damage-associated molecular-pattern molecules (DAMPs), as well as the specific antigens of tumor cells, are released. The immune system reacts to them, which stimulates both local and general immune responses. As a result, the body copes with most of the cancer cells on its own.



Immunotherapy is a new treatment method for stage 4 liver cancer, which consists of stimulating the immune response thanks to specific drugs – checkpoint inhibitors. This treatment method is based on the influence on particular receptors of cancer cells, which help the tumor to avoid an immune response. If their activity is suppressed, the immune system will be able to detect pathological cells and resist their development.

Two drugs from checkpoint inhibitors are currently approved for stage four cancer. They can be used as adjunctive therapy after other procedures for the treatment of liver cancer.

Some hospitals abroad are already using drugs which block the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4). The investigations demonstrated a good effect of these drugs: disease control was achieved in more than 75% of patients. Another immune checkpoint inhibitor drug targets PD-1 proteins. During the investigations, it showed a response in 60% of patients. In half of these patients, the use of PD-1 inhibitors allowed the doctors to control the disease for 15 months or more.

Benefits of stage 4 liver cancer treatment in Germany


Liver cancer treatment in Europe offers the following benefits for patients:

  • German hospitals offer all progressive treatment methods, which allows the doctors to achieve long-term control of the disease in many patients.
  • Oncology hospitals have only the best and the most modern equipment, which ensures the accuracy of all their procedures.
  • Specialists from various fields of oncology undergo long-term training and receive qualifications, which allows them to implement all of the modern treatment methods in practice.
  • European hospitals are fully equipped for a comfortable stay for patients.

The leading hospitals that offer the best treatment for IV stage liver cancer:

  1. University Hospital of Ludwig Maximilian University of Munich, Department of Gastroenterology and Hepatology
  2. University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology
  3. University Hospital Ulm, Department of Gastroenterology and Hepatology
  4. University Hospital Carl Gustav Carus Dresden, Department of Gastroenterology and Hepatology
  5. Charite University Hospital Berlin, Department of Hepatology and Gastroenterology

You can find a full list of the specialized healthcare facilities on the Booking Health website.

How to undergo treatment in Germany?


To undergo personalized treatment for stage 4 cancer in the best oncology hospitals in Germany, you can use the services of Booking Health. If you contact us, you will get qualified assistance and save time, because it is not easy to organize your own treatment in Germany. We can help you to take care of the following things within a short period of time:

  • selection of the best medical center for your diagnostics and treatment of stage 4 liver cancer, based on the annual reports;
  • preparation of the diagnostic and treatment program, taking into account previous examinations;
  • provision of a favorable average cost of treatment and other services provided by the hospital, without any extra charges or coefficients for foreign patients (saving you up to 50%);
  • doctor's appointment on your desired date;
  • control of the medical program at all its stages;
  • assistance in buying and forwarding medicines;
  • communication with the hospital after your treatment’s completion;
  • monitoring of invoices and return of any unspent funds;
  • organization of additional diagnostic examinations;
  • booking hotels, airline tickets, transfers, and interpreting services.

To get professional help from the specialists at Booking Health and find out the prices, please leave your request on our official website.


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The article was edited by medical experts, board certified doctors Dr. Nadezhda IvanisovaAlexandra Solovey. 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!

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