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Ovarian cancer is one of the most common gynecologic cancers, which ranks second in incidence among all types of cancer. It is most often diagnosed in women above 45 years old. When undergoing treatment in Europe, doctors use the very latest treatment methods for stage 4 cancer, which allow them to increase the life expectancy of patients and get a good prognosis.
- Classical treatment methods and their disadvantages
- Modern treatment methods for stage 4 ovarian cancer
- Why is it worth undergoing treatment of stage 4 ovarian cancer in German hospitals?
- How to undergo treatment in Germany?
Classical treatment methods and their disadvantages
The stage 4 ovarian cancer is characterized by metastases in distant organs and in the liver parenchyma, as well as by the 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 is played by three 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, anticancer and radiation therapy. They demonstrate good survival rates and are more effective than classical protocols.
Modern treatment methods for stage 4 ovarian cancer
The treatment of stage 4 ovarian cancer is aimed at prolonging and improving the quality of life of patients, preventing the development of complications and their elimination. To provide successful treatment, Germany uses such advanced methods 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.
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 4 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 tumor foci, small metastases which 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 achieving the following effects:
- The local use of 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 drugs and the drug can better penetrate into cancer cells.
- The drugs remain in the ovarian tissues for a long time and continue to act without causing side effects and 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 stage 4 cancer by several times as compared to cytoreductive surgery performed without follow-up HIPEC (75% versus 18%).
Embolization of metastases
Metastatic ovarian cancer often spreads tumor foci into the liver parenchyma. One of the options for their control is hepatic artery embolization. The method consists in blocking 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 receives most of the blood from the portal vein, while 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:
- Poor blood supply – cancer cells die quickly, since the vessels feeding them are blocked.
- 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 for the patients who have contraindications for surgical removal of the tumor.
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 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 was not performed.
- Tumor foci with a diameter of more than 1 cm remained 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 cancer cells after chemotherapy. These medicines are prescribed as pills or capsules in the case of detection in 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 required for cell survival and division. These drugs are manufactured as pills.
Most ovarian tumors are sensitive to radiation. Irradiation allows obtaining 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. The 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, 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 when the tumor is insensitive to chemotherapy. Then recurrent tumors or metastases are subject to irradiation.
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, only in clinical trials. Up to 15% of patients receive positive results – survival rate reaches 20 months.
Why is it worth undergoing treatment of stage 4 ovarian cancer in German hospitals?
Medicine in Germany is constantly developing and is available to patients from any country in the world. The treatment of stage 4 ovarian cancer in most cases is 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 a minimum risk 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.
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. The quality of the company's work is confirmed by the prestigious international ISO 9001:2015 certification.
Booking Health provides the following services:
- Individual selection of a diagnostic and treatment program in a specialized German hospital.
- Preparation of a medical program taking into account previously performed diagnostic and therapeutic procedures.
- Provision of a minimum cost of treatment – 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 dates.
- Preparation of documents and insurance against unforeseen complications.
- Quality control of the medical program at all its stages.
- Monitoring of invoices and return of 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 at the airport and transfer.
- Communication with the treating oncologist after returning to your native country.
You can find out more information about the treatment programs and the cost of medical services by sending your request on the official bookinghealth.com website.
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