Treatment of stage 4 colon cancer in Germany | Booking Health

Treatment of stage 4 colon cancer in Germany

The article was reviewed by an expert in the field of medicine Prof. Dr. med. Thomas Vogl
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If you need detailed information on methods and costs of treating earlier-stages colon cancer, you'll find it here.

Colon cancer (ICD C18) is one of the five most common malignant tumors in the world, and it ranks third. The average age of most patients is 60-75 years, but the disease can develop in people between the ages of 40 and 50 years old. Good treatment outcomes, even at stage 4 cancer, can be achieved with the usage of innovative methods that are widely practiced in German hospitals.


  1. Standard treatment of colon (bowel) cancer and its disadvantages
  2. The latest and the most effective treatment of stage 4 colon cancer in Germany
  3. Why is it worth undergoing treatment in Germany?
  4. The best hospitals for treatment of 4 stage colon (bowel) cancer
  5. Organization of treatment for colon (bowel) cancer stage 4 in Germany

Standard treatment of colon (bowel) cancer and its disadvantages


Stage 4 colon cancer is diagnosed if a patient has distant metastases and extensive tumor spread. It occurs due to the migration of cancer cells through blood and lymph, as well as through abdominal tissues.

The standard treatment for most patients is chemotherapy and surgical removal of the tumor. The classic regimens for these methods have significant drawbacks. These include:

  • Chemotherapy usually involves an intravenous injection of anticancer drugs that allows active agents to penetrate the colon at low concentrations. At the same time, the drugs affect the healthy cells of the whole body, thereby causing severe side effects.
  • Chemotherapy requires a long course and money.
  • Open surgery involves a large area of ​​intervention in the abdominal cavity. It is a complex challenge for the weakened body of patients, which requires a long rehabilitation period.
  • All of them are ineffective and do not prolong the lives of patients.

European hospitals apply improved algorithms for standard treatment since they are less toxic and safer for the patient. They also use minimally invasive interventions, including robot-assisted ones, with minimal risk of complications.

The latest and the most effective treatment of stage 4 colon cancer in Germany


A new treatment for sigmoid colon cancer stage 4 in German hospitals aims to destroy as many cancer cells as possible, eliminate symptoms and prolong the patients' lives. A man or woman needs to be thoroughly diagnosed in order to choose the right treatment to achieve all these goals. The patient can be prescribed such treatments as new types of chemotherapy, low-traumatic surgery, immunotherapy, and various procedures to eliminate negative symptoms. As a rule, several methods are used simultaneously.

Advanced surgical techniques for colon (bowel) cancer treatment


In stage 4 colon cancer, many patients can undergo surgical removal of the tumor. Such procedures are called cytoreductive surgeries. The doctor's task is to remove as much of the tumor tissue as possible. The best results can be achieved by removing all visible areas of the tumor's spread.

After well-performed surgical procedures and additional drug therapy, the five-year survival rate of patients with IV stage colon cancer reaches 58%, and many of them live for more than 10 years. These results are significantly better as compared to standard surgery: patients live on average 12-15 months after them.

Metastases often develop not only in the abdomen but also in the lungs. In this case, the patient can undergo surgery to remove them. With a single metastasis, this may be an atypical resection – a sparing surgical procedure involving the removal of a small amount of lung tissue. With multiple metastatic lesions, lobectomy or pneumonectomy (removal of a lobe or the entire lung) may be performed. Specialized German hospitals perform robot-assisted surgery, which reduces the invasiveness of interventions and the risk of complications.

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Treatment of stage 4 colon cancer in Germany


Hyperthermic intraperitoneal chemotherapy for colon (bowel) cancer


More and more German hospitals use hyperthermic intraperitoneal chemotherapy (HIPEC) instead of conventional chemotherapy. The procedure consists in flushing the abdominal cavity with a chemotherapy solution heated to 42-43 °C. It shows the best results since such an approach provides several advantages at once:

  • It is possible to use higher concentrations of drugs with localized introduction, which is unavailable with systemic chemotherapy because of the risk of complications.
  • The high temperature of the solution enhances the effect on cancer cells and improves the penetration of drugs into tumor tissues.
  • The drugs can remain in the colon for a long time and continue to act. However, they are not absorbed into the bloodstream and do not cause systemic side effects (such signs as nausea, abdominal pain, loose stools, etc.).

Hyperthermal chemotherapy for stage 4 colon cancer is performed in combination with the surgical removal of tumor foci in the abdominal cavity, thereby increasing the effectiveness of surgical interventions. It is because, even after the operation, there are no visible tumor foci at all, the presence of previously undetected cancer cells cannot be completely excluded. As a result, the positive effect of such treatment is greatly increased.

Immunotherapy for colon (bowel) cancer stage 4


Immunotherapy may be prescribed as a treatment for fourth stage colon cancer, which is developed due to cancer in other organs (metastatic cancer). It involves the administration of drugs that block certain molecules on the surface of cancer cells. Such drugs do no affect on the tumor. They only prevent it from evading the immune response and help the body eliminate the pathology on its own.

Immunotherapy for stage 4 cancer allows achieving the following effects:

  • Reducing tumor size and stopping its further development.
  • Activating the immune system, which can reduce the number of metastases.
  • Minimizing side effects. As a rule, the last ones are not severe and disappear a few days after therapy.

Checkpoint inhibitors targeting specific PD-1 and CTLA-4 proteins are used in clinical practice for colon cancer immunotherapy. They are injected intravenously once every 3 weeks.

Adoptive immunotherapy is already used for many cancers. The treatment essence consists in extracting immune cells from the patient's blood, activating them, cultivating them to increase their number, and injecting them into the body. If successful, activated lymphocytes attack the tumor and its metastases.

Currently, several new types of vaccines are being developed: drugs from tumor cells, viral vectors, dendritic cells, and isolated peptide antigens. For now, none of these vaccines are being implemented into the standard treatment of colorectal cancer.

Embolization of metastases stage 4 colon (bowel) cancer


Palliative procedures and surgery are performed to relieve symptoms and eliminate complications. They can restore patency in the gastrointestinal tract, eliminate jaundice, and bleeding. The most common methods are embolization, colonoscopy, and surgery.

Embolization is a procedure, which implies the blockage of blood vessels, which supply malignant tumors. For this purpose, various chemical agents (emboli) are used. Doctors in Germany prefer using microspheres – emboli, which are saturated with chemotherapy drugs (transarterial chemoembolization). In this case, the tumor can be eliminated not only due to the blockage of blood flow but also due to the prolonged influence of chemotherapeutic agents, which are released gradually from the microspheres over several weeks. This procedure is carried out using a catheter through a small incision in the groin.

Liver metastases develop in 85% of patients with advanced cancer. They can be removed surgically only in 20% of patients. In the rest, doctors use other treatment methods. Chemoembolization in colon cancer treatment with liver metastases is a minimally invasive and very effective procedure that allows doctors to reduce metastatic foci by several times. The damage to healthy liver parenchyma is minimal – cancer cells die, but the liver function is preserved.

At the advanced stage of colon cancer, bleeding occurs in 10% of patients, while massive blood loss occurs in 2% of cases. Most bleedings can be eliminated with a colonoscopy, but the doctor cannot always find the source of severe bleeding. Therefore, in severe cases, doctors resort to embolization of intestinal vessels.


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Radiation therapy for colon (bowel) cancer stage 4


Radiation therapy for stage four colon cancer is rarely carried out. It is usually indicated in the presence of metastases in other organs. Nowadays, Germany offers new types of radiation therapy, which reduce the risk of post-radiation side effects. These include brachytherapy and stereotactic radiosurgery. They allow doctors to direct the radiation source precisely to the affected tissues with millimeter accuracy, leaving healthy cells intact.

Why is it worth undergoing treatment in Germany?


The healthcare system in Germany is recognized all over the world. Every year the government allocates huge funds for advanced training courses for doctors and all medical staff, scientific research, and equipment in hospitals. Here, patients from different countries of the world receive the most modern and effective treatment available today.

The specialists of the medical facilities monitor the quality of the services provided at all stages. In addition, due attention is paid to rehabilitation and the well-being of patients.

The best hospitals for treatment of 4 stage colon (bowel) cancer


The following hospitals specialize in the treatment of advanced bowel cancer:

  1. University Hospital Duesseldorf, Department of Gastroenterology, Hepatology, and Infectology. The department is part of the certified Center for the Treatment of Bowel Diseases; all types of surgical interventions and systemic therapy are carried out here. In addition to cooperation with other departments of the university hospital, the department has 10 own specialized outpatient clinics.
  2. University Hospital of Ludwig-Maximilian University of Munich, Department of Gastroenterology and Hepatology. The department specializes in endoscopic methods of bowel cancer treatment. Since 2016, the head physician of the department, Professor Julia Mayerle, has been a board member of the European Association of Gastroenterologists, Endoscopists and Nutritionists (EAGEN).
  3. University Hospital Ulm, Department of Gastroenterology and Hepatology. The department is mentioned among the best German medical facilities for the treatment of bowel cancer according to the FOCUS magazine. It is a part of the Comprehensive Cancer Center Ulm (CCCU). The high success rates of the department's work are confirmed by the certificate of the German Cancer Society, the ISO 9001:2008 SGS certificate and other ones.
  4. University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology, and Diabetology. The department offers interdisciplinary treatment of bowel cancer, with particular emphasis on the patient’s quality of life after the completion of the therapeutic course. The head physician of the department, Professor Stefan Zeuzem, is a member of the German Cancer Society (DKG).
  5. University Hospital Wuerzburg, Department of Gastroenterology, Hematology, Oncology, Hepatology, Infectology, Rheumatology, and Clinical Immunology. The department offers classical treatments for bowel cancer with proven efficacy, as well as the opportunity to participate in clinical investigations. At the same time, doctors actively cooperate with the Interdisciplinary Cancer Center Mainfranken.

Organization of treatment for colon (bowel) cancer stage 4 in Germany


You can undergo the treatment of stage 4 cancer in one of the German oncology hospitals by contacting Booking Health. Our company is the leader in medical tourism and serves patients from all over the world. Our qualified managers will contact you as soon as possible and discuss all the details of the desired trip for treatment in one of the German hospitals.

If you contact us, we will help you with the following issues:

  • Selection of a specialized hospital and treatment program in Europe based on the annual reports
  • Preliminary consultation with a doctor and booking an early appointment
  • Preparation of a personalized diagnostic program considering previously performed diagnostic examinations
  • Reduced cost of treatment, without additional fees and coefficients for foreign patients (savings up to 50%)
  • Monitoring of the quality of staff work at all treatment stages
  • Assistance in buying and forwarding medicines
  • Monitoring of invoices and return of unspent funds
  • Organization of additional screenings, examinations and procedures if required
  • Provision of interpreting services
  • We will fully organize your trip, book airline tickets and a hotel room, meet you at the airport and take you to the hospital by car

On our website you will find detailed information about the best hospitals and doctors. The average cost of treatment depends on the type of colon cancer. To find out prices and more detailed information, please fill out a request form and send it to us.


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The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Alexandra 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!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.



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