Treatment of stage 4 ovarian cancer in Germany

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

Ovarian cancer is one of the most common gynecologic cancers, it ranks second in incidence among all types of cancer. It is most often diagnosed in women over 45 years old. Screening and increased awareness are crucial in detecting ovarian cancer early before it reaches stage 4, a terminal phase often accompanied by severe pain and limited treatment options. When undergoing treatment in Europe, doctors use the very latest treatment methods for stage 4 cancer, which allows them to increase the life expectancy of patients and give a good prognosis.

Content

1. Classical treatment methods and their disadvantages
2. Modern treatment methods for stage 4 ovarian cancer in Germany
   • Surgical intervention as treatment for stage 4 ovarian cancer in Germany
   • Hyperthermic intraperitoneal chemotherapy
   • Embolization of metastases in Germany
   • Targeted therapy for the treatment of stage 4 ovarian cancer in Germany
   • Radiation therapy for the treatment of stage 4 ovarian cancer in Germany
   • Immunotherapy for the treatment of stage 4 ovarian cancer in Germany
3. The best hospitals for treatment of 4 stage pancreatic cancer
4. How to undergo treatment in Germany?

Classical treatment methods and their disadvantages

Stage 4 ovarian cancer (sometimes incorrectly referred to as grade 4 cancer) is characterized by metastases in distant organs (stomach, liver parenchyma, lymph nodes) as well as by malignant cells in the pleural fluid and the invasion of the primary tumor into the rectum.

The main role in the treatment of the advanced stages of ovarian cancer, when a tumor is no longer localized, is played by three different methods: chemotherapy, radiation therapy, and surgery. However, the use of classical medical protocols is associated with the following risks:

• Chemotherapy drugs are highly toxic and affect not only malignant cells but also healthy ones;
• Standard radiation therapy involves total body irradiation, and therefore, patients experience severe side effects;
• Surgery usually requires thoracotomy and long-term postoperative rehabilitation;
• Surgical intervention does not allow the surgeons to remove all tumor foci, and therefore, there is a possibility of recurrence (repeated development of the process);
• All treatment protocols are quite expensive.

European hospitals have developed improved surgical techniques, and anticancer and radiation therapy. They demonstrate good survival rates and are more effective than classical protocols.

Modern treatment methods for stage 4 ovarian cancer in Germany

The treatment of the fourth stage ovarian cancer is aimed at prolonging and improving the quality of life of patients and preventing or eliminating the development of complications. As conventional therapies may not be effective at this advanced stage, many patients explore alternative treatments and seek enrollment in clinical trials for innovative approaches. To provide successful treatment, Germany uses advanced methods and alternatives, such as embolization of metastases, cytoreductive surgery, systemic anticancer therapy, and others. The choice of therapeutic tactics depends on the type and size of the neoplasm.

Surgical intervention as treatment for stage 4 ovarian cancer in Germany

It is often advisable to undergo surgical treatment for stage 4 cancer. Considering the spread of the tumor, German doctors perform cytoreductive surgery, which involves the removal of all visible tumor foci and metastases.

The following two approaches are widely used:

• Primary cytoreductive surgery, which is the removal of the maximum possible volume of the neoplasm and metastases, prior to chemotherapy;
• Interval cytoreductive surgery, which is the surgical removal of the tumor after a short course of chemotherapy for stage four ovarian cancer. This technique is increasingly used, since it reduces tumor size and increases the likelihood of its total removal during surgery.

The doctors in Germany give preference to surgical interventions using laparoscopic equipment and robot-assisted systems. This allows them to perform surgical procedures through small skin incisions, precisely control the course of the procedure, eliminate the risk of medical errors, and reduce the period of postoperative recovery.

Hyperthermic intraperitoneal chemotherapy

Even if doctors manage to remove all visible lumps, small metastases that cannot be detected visually may still remain in the abdominal cavity. These metastases can cause recurrence. Hyperthermic intraperitoneal chemotherapy (HIPEC) is an innovative, local chemotherapy technique, which is often used to prevent the repeated development of the tumor after cytoreductive surgery.

The essence of the procedure is that the abdominal cavity is washed using drainage systems, with a solution of chemotherapy drugs heated to 40-42 °C. This allows for the achievement of the following effects:

• The local use of a high concentration of chemotherapy drugs, which cannot be done when conducting systemic chemotherapy, due to its excessive toxicity;
• The high temperature of the solution enhances the antitumor properties of the drugs and the drugs can better penetrate into the cancer cells;
• The drugs remain in the ovarian tissues for a long time and continue to act without causing side effects or the impairment of healthy organs.

The duration of the procedure is from 30 to 90 minutes. Studies have shown that HIPEC increases the survival rate of patients with IV stage cancer by several times, when compared to cytoreductive surgery performed without follow-up HIPEC (75% versus 18%).

Embolization of metastases in Germany

Metastatic ovarian cancer often spreads tumor foci into the liver parenchyma. One of the options for their control is hepatic artery embolization. This method consists of blocking the blood flow in the vessel, which stops the blood supply to the metastases. For this purpose, various chemical agents (emboli) are used.

Embolization in liver metastases has the following advantages:

• Rapid reduction of tumor size or metastatic lesions;
• Minimal invasiveness – the procedure is performed through a small incision in the groin using a catheter;
• Good tolerability of the procedure;
• The possibility of repeated use of the procedure;
• Preservation of liver function – healthy parenchyma receive most of the blood from the portal vein, whilst the tumor receives 95% of its blood from the hepatic artery.

German hospitals are increasingly using transarterial chemoembolization – a type of embolization which applies microspheres imbued with chemotherapy drugs as emboli. When using the procedure, the therapeutic effect is achieved due to the following two mechanisms:

1. Poor blood supply – cancer cells die quickly, since the vessels feeding them are blocked;
2. Effect of chemotherapeutic agents – chemotherapy drugs are evenly released from microspheres for several weeks and suppress the vital activity of cancer cells.

Chemoembolization in the treatment of ovarian cancer with liver metastases can be indicated as a choice for patients who have contraindications for surgical removal of the tumor.

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Targeted therapy for the treatment of stage 4 ovarian cancer in Germany

The method of targeted therapy is based on the use of drugs which affect the molecular mechanisms of proliferation and division of cancer cells. Such drugs are selected individually, depending on the presence and type of mutations in the tumor cells. In stage 4 ovarian cancer, this treatment is used in combination with systemic chemotherapy to reduce the size of the tumor and its metastases.

Targeted therapy can be indicated for patients, if:

• Cytoreductive surgery has not been performed;
• Their tumor foci have a diameter of more than 1 cm and remain after cytoreduction.

When treating metastatic ovarian cancer, the doctors most often use angiogenesis inhibitors. These are drugs that block the formation of new vessels supplying the tumor. These are mostly antibodies which affect the VEGF protein. The course includes about 20 injections of drugs, which are administered intravenously once every 3 weeks.

Some patients may be prescribed PARP inhibitors. These are drugs that interfere with the restoration of DNA in the cancer cells after chemotherapy. These medicines are prescribed as pills or capsules in the case of detection of patient specific mutations in the BRCA genes.

NTRK mutations are rare. The drugs from the group of tropomyosin receptor kinase inhibitors are most suitable for such patients. They block the activities of growth factors that are required for cell survival and division. These drugs are manufactured as pills.

Radiation therapy for the treatment of stage 4 ovarian cancer in Germany

Most ovarian tumors are sensitive to radiation. Irradiation allows doctors to obtain an objective response to therapy in 85% of patients – it reduces symptoms and prevents the development of complications. Radiation therapy is also used at the advanced stages of the disease as a palliative treatment option.

Metastatic foci can also be irradiated. This therapy involves the use of modern technologies, ensuring a minimal risk of developing post-radiation complications:

• Brachytherapy is a method of contact radiation therapy which involves the placement of a radiation source close to the areas of the body affected by cancer. Brachytherapy allows the doctors to use higher doses of radiation without damaging healthy tissue during treatment. Brachytherapy is usually prescribed for metastases in the cervix and uterus, vagina, and rectum;
• Stereotactic radiosurgery is irradiation using equipment which allows the doctors to determine the exact coordinates of the tumor and act on it with beams at different angles. The metastases are mostly subject to radiation in hard-to-reach areas of the body – bones, brain and spinal cord.

Radiation therapy for ovarian cancer is also used in cases where the tumor is insensitive to chemotherapy. Then, any recurrent tumors or metastases are subject to irradiation.

Immunotherapy for the treatment of stage 4 ovarian cancer in Germany

Immunotherapy is a promising method of drug therapy with checkpoint inhibitors. These drugs block protein molecules on the surface of abnormal cells, which mask the tumor and help it avoid an immune response.

Immunotherapy for ovarian cancer is still rarely used, usually only in clinical investigations. Up to 15% of patients receive positive results – the survival rate reaches 20 months.

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The best hospitals for treatment of 4 stage ovarian cancer

Medicine in Germany is constantly developing and is available to patients from any country in the world. The treatment of stage 4 ovarian cancer is, in most cases, successful. Upon the completion of treatment, many people live more than 5 years, even with metastases. This is possible due to the following aspects:

• Top-class specialists – each doctor undergoes specialized training and medical practice in the best health facilities in the world. This allows them to perform minimally invasive procedures and surgery of any complexity;
• Technical equipment at the hospitals – the medical facilities use modern equipment, which allows the surgeons to perform minimally invasive, organ-preserving surgery with minimum risks of complications;
• Advanced treatment methods – new treatment protocols are constantly being developed and introduced into clinical practice, which increases the effectiveness of therapy.

One can undergo specialized treatment of ovarian cancer in more than 70 German hospitals. The leading healthcare facilities are:

Hospital	Department
University Hospital Tuebingen	Department of Adult and Pediatric Gynecology, Mammology, Obstetrics offers classic therapeutic protocols and own developments for the treatment of advanced ovarian cancer. In addition to basic treatment, women receive psychological help. The head of the department, Professor Diethelm Wallwiener, is the representative of the working group Gynecological Oncology (AGO) in the Clinical Research Commission.
Leverkusen Clinic	Department of Gynecology, Urogynecology, Mammology and Obstetrics specializes in laparoscopic interventions and robot-assisted da Vinci surgery. With these techniques, ovarian tumors and tissues affected by the oncological process are accurately removed. The head physician of the department, Professor Kubilay Ertan, is a member of many specialized societies: the European Society of Gynecological Oncology (ESGO), the German Cancer Society (DKG), the American Society of Clinical Oncology (ASCO) and others.
University Hospital Ulm	Department of Obstetrics, Adult and Pediatric Gynecology is headed by Professor Wolfgang Janni, who is mentioned in the FOCUS ranking of the best German doctors in the field of treatment of gynecological tumors. The department provides a full range of systemic treatments, including the use of specific antibodies (targeted therapy). If necessary, surgical interventions are performed in modern operating rooms.
University Hospital Rechts der Isar Munich	Department of Gynecology, Mammology and Obstetrics is part of the specialized oncology center, where gynecologists, oncologists, surgeons, radiation therapists, specialists in the field of nuclear medicine, and psychologists cooperate. Minimally invasive and robotic surgery can remove tumor metastases, while systemic methods of treatment prevent its progression. The department also carries out genetic tests for more individual therapy planning.
Helios Hospital Berlin-Buch	Department of Gynecology, Mammology and Obstetrics is certified by the German Cancer Society as a Center for Gynecological Oncology. One of its areas of specialization is surgical treatment: more than 3,000 interventions are performed here annually. The head physician of the department, Professor Michael Untch, is a member of the Guideline Development Committee of the Working Group on Gynecological Oncology.

How to undergo treatment in Germany?

To undergo high-quality treatment of stage 4 ovarian cancer in the leading oncology hospitals in Germany, you can use the services of Booking Health – the official medical tourism organizer.

Booking Health provides the following services:

• Personalized selection of a diagnostic and treatment program in a specialized German hospital;
• Preparation of a medical program, taking into account any previously performed diagnostic and therapeutic procedures;
• Provision of minimum cost treatments – prices will be reduced due to the lack of additional coefficients for foreign patients;
• Organization of a preliminary consultation with a doctor;
• Doctor's appointment on the most suitable date;
• Preparation of documents and insurance against unforeseen complications;
• Quality control of the medical program at all its stages;
• Monitoring of invoices and return of any unspent funds;
• Assistance in buying and forwarding medicines;
• Prompt organization of additional procedures and follow-up rehabilitation;
• Buying airline tickets, booking an apartment or a hotel, meeting you at the airport, and transfers;
• Communication with the treating oncologist after returning to your native country.

You can find out more information about the treatment programs and the average cost of treatment by sending your request on the official bookinghealth.com website.

 

Send request for treatment

 

Choose treatment abroad and you will be sure to get the best results!

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See the interview for more information:

CHEMOEMBOLIZATION AND OTHER METHODS OF THE ADVANCED-STAGE CANCER TREATMENT – interview with Prof. Dr. med. Thomas Vogl

Authors:

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.

 

Source:

American Cancer Society

National Cancer Institute

Web MD

 

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