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Pancreatic cancer is one of the most common gastrointestinal cancers. More than 300,000 new cases are diagnosed in the world every year. This tumor accounts for 3% of all cancers, which is a fairly high figure. The treatment methods offered in Germany allow achieving excellent results even at stage 4 pathology.
- Standard treatment and its risks
- New treatment methods for stage 4 pancreatic cancer in Germany
- Symptomatic treatment
- Why is it worth undergoing treatment in German oncology hospitals?
- Leading hospitals and cost of treatment
- How to undergo treatment in Germany?
Standard treatment and its risks
Stage 4 pancreatic cancer is diagnosed when the tumor invades into the surrounding organs and spreads distant metastases.
The main treatment methods are chemotherapy and radiation therapy. This type of pathology can not be treated with surgery, and therefore doctors use various procedures to alleviate the patient's condition and eliminate complications. The use of classical treatment algorithms entails certain risks. These are the following:
- When carrying out radiation therapy, good results can be achieved only with the use of high doses of radiation, but this is quite difficult, since standard methods of radiation therapy have severe side effects. There are many other organs near the pancreas, which can be damaged by radiation.
- Classical chemotherapy for stage 4 pancreatic cancer has a toxic effect on the healthy tissue and causes severe side effects.
- All standard protocols require a long treatment course and are very expensive.
- Almost all standard procedures have an unstable effect.
Germany uses improved standard treatment methods and advanced medical protocols, which are more effective and demonstrate high survival rates in patients.
New treatment methods for stage 4 pancreatic cancer in Germany
The treatment for stage 4 pancreatic cancer helps the patients to improve the quality of their life and condition, prevent the development of complications or get rid of them. Embolization and chemoembolization of metastases are used for local control of the tumor and increase in life expectancy. Drug therapy involves not only chemotherapy, but also targeted therapy and immunotherapy. German doctors also pay due attention to the treatment of symptoms.
Embolization of metastases
The embolization technique is aimed at blocking blood vessels supplying the pancreatic tumor and its metastases. For this purpose, doctors use emboli in their medical practice. Emboli are various chemicals.
Recently, German doctors are increasingly using one of the varieties of the procedure – selective transarterial chemoembolization. This method involves the introduction of microspheres imbued with chemotherapy drugs as emboli.
Chemoembolization in cancer treatment contributes to the cessation of blood flow in the tumor, which leads to oxygen starvation of cancer cells and their death. In addition, an embolus gradually releases a large number of chemotherapy drugs, which destroy the tumor and prevent its repeated growth.
This method has the following advantages:
- It allows reducing the tumor size, so that it is possible to perform surgery.
- It increases life expectancy of patients with inoperable tumors.
- The procedure is absolutely safe – side effects develop only in 2-5% of cases and they can be easily eliminated with the help of symptomatic treatment.
- It allows using an increased concentration of chemotherapy drugs, which cannot be applied in case of systemic chemotherapy due to its high toxicity.
- Antineoplastic drugs affect only the pathological focus while leaving healthy cells intact.
- It does not require a long rehabilitation period.
To perform the procedure, doctors firstly inject the contrast agent and assess its distribution in the vessels using X-ray imaging. A microcatheter is then inserted into the vessels, through which emboli are delivered to the target arteries.
Embolization is most often performed through a transfemoral access – the doctor makes an incision in the groin area. If this access cannot be used, the doctor can also insert a catheter through the axillary or brachial artery. In some hospitals, the procedure is performed through the radial artery, which reduces the risk of local complications by 3 times and does not require bed rest during the day. If the patient has liver metastases, the hepatic artery will be blocked by emboli.
Radiation therapy for stage 4 metastatic pancreatic cancer allows controlling the disease and reducing the severity of negative symptoms. The irradiation of metastases in distant organs is also often carried out.
In order to use high doses of radiation without the risk of side effects, Germany uses the very latest radiation therapy methods. The most popular of them is stereotactic 3D conformal radiation therapy, which has the following advantages:
- It accurately acts on the tissues affected by cancer without involving healthy parts of the body in the process.
- It allows the doctor to accurately determine the amount of radiation and control the process using computed tomography.
- It allows the specialists to modulate the intensity of the beams.
- The procedure is performed on high-tech equipment.
- Patients tolerate the procedure well and recover quickly.
- The method is versatile and can help even in severe cases.
Some German hospitals also offer proton therapy, which is the most modern method of radiation therapy distinguished by a combination of high efficiency and a sparing effect on the human body. Proton therapy uses protons as an energy source, but not X-rays. Such an approach minimizes the risks of post-radiation complications.
In modern medicine, targeted therapy is becoming more and more popular. This is drug therapy that affects the cellular mechanisms of tumors. The fact is that cancer cells can contain many protein molecules, which support their growth and multiplication. They appear due to specific mutations in genes. Medicines can block the activity of such molecules and reduce the tumor size. Targeted therapy works especially well when it is combined with chemotherapy.
To treat stage 4 pancreatic cancer, doctors in Germany use EGFR inhibitors – drugs, which block the activity of the EGFR protein. The last one ensures the rapid growth of cancer cells. As a result, the tumor grows slowly and stabilizes in size. This drug is taken in the form of tablets once a day.
If the NTRK gene has mutations, the treatment may involve the use of receptor tyrosine kinase inhibitors. The drugs of this group block the activity of growth factors, which are required for cellular activity. They started to be used recently: since 2018 – in the United States, and since 2019 – in Europe.
Stage 4 pancreatic cancer is rarely characterized by MMR gene mutations and unusual types of the molecular pathogenesis of the tumor – microsatellite instability (MSI-H). In such cases, it is possible to use immunotherapy – treatment with drugs from the group of checkpoint inhibitors. The active substances of these drugs are able to block certain molecules on the surface of cancer cells, allowing the tumor to avoid immune attack.
Checkpoint inhibitors (blockers) do not damage cancer cells. They only reduce the ability of the tumor to conceal itself from the immune system. Therefore, this therapy does not cause any complications and is well tolerated. When combined with chemotherapy, this treatment demonstrates excellent results – the tumor is reduced in size and well controlled.
Other methods of immunotherapy can also be used within the framework of clinical trials. These include antibodies acting on the carcinoembryonic antigen (CEA), as well as anti-cancer vaccines based on dendritic cells.
At the advanced stage of pancreatic cancer, patients often have jaundice, pain and bowel obstruction in the duodenum. In such cases, it is advisable to carry out symptomatic treatment of complications.
Narcotic analgesics are usually used to relieve pain, but since such drugs give a clinical effect only in 30% of cases, most patients undergo various procedures and surgical interventions.
The following methods allow the doctors to achieve a stable analgesic effect:
- Chemical neurolysis is the destruction of the celiac plexus by special substances. The procedure can be used independently or during surgery to eliminate jaundice. The effectiveness of the procedure is more than 80%. The pain does not return within 4-5 weeks.
- Thoracoscopic splanchnicectomy is a minimally invasive surgery to remove both large and small celiac nerves. It is performed through small incisions in the thorax. The intervention becomes an option of choice if chemical neurolysis is ineffective. The method always gives positive results, and the effect lasts for more than 3 months in 70% of patients.
The tumor at stage 4 compresses the bile ducts, so pancreatic head cancer always causes jaundice. There is a large number of operations and minimally invasive procedures for its treatment:
- Surgery involves the formation of biliodigestive anastomoses – additional bypass for the outflow of bile into the intestine.
- Percutaneous puncture and endoscopic procedures are used to allow bile to drain out into the intestine or to dilate the bile ducts with a stent (a metal hollow tube, which is inserted into the affected duct).
In some patients, the malignant tumor compresses the duodenum. In this case, to restore its patency, doctors perform stent implantation or form a bypass (anastomosis) to provide the free movement of food masses into the lower intestines.
Why is it worth undergoing treatment in German oncology hospitals?
The patients from all over the world can undergo high-quality cancer treatment in German hospitals. In most cases, therapy at the advanced stages of pancreatic cancer is successful – doctors prolong the life of patients and improve its quality several times. This is possible due to the following aspects:
- Modern diagnostics – molecular genetic tests of cancer cells, which allow the doctors to individually select an effective treatment method.
- The best equipment and medicines – German hospitals have modern equipment and the very latest drugs.
- Innovative methods – German hospitals constantly develop and implement new therapeutic approaches for cancer treatment.
- Leading specialists – prior to obtaining a license, German oncologists undergo long training and internship in the best medical facilities in the world.
Every year the government of the country allocates huge funds for the development of the medical sector, which determines the high level of medicine in Germany.
Leading hospitals and cost of treatment
Stage 4 pancreatic cancer is treated by a tumor board which includes gastroenterologists, oncologists and surgeons. As a rule, such tumor boards are available in large university hospitals:
- University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology
- University Hospital of Ludwig-Maximilian University of Munich, Department of Gastroenterology and Hepatology
- University Hospital Ulm, Department of Gastroenterology and Hepatology
- University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
- University Hospital Würzburg, Department of Gastroenterology, Hematology, Oncology, Hepatology, Infectology, Rheumatology and Clinical Immunology
The cost of the main types of treatment is as follows:
- Segmental pancreas resection in pancreatic cancer – from €32,105
- Whipple procedure (pancreaticoduodenal resection) in pancreatic cancer – from €32,181
- Treatment of pancreatic cancer with bile duct stenosis with ERCP – from €6,858
- Pancreatic cancer treatment with chemotherapy and radiation therapy – from €12,660
- Treatment of pancreatic cancer by embolization or chemoembolization – from €24,070
- Pancreatic cancer treatment with chemotherapy – from €2,485
- Proton therapy for pancreatic cancer – from €44,275
- Rehabilitation after completion of the main course of treatment – from €951 per day
How to undergo treatment in Germany?
To undergo high-quality treatment for stage 4 pancreatic cancer in leading European hospitals, you can use the services of Booking Health – an international medical tourism organizer. The high quality of services of the company is confirmed by the prestigious international ISO 9001:2015 certification.
Booking Health offers the following services:
- Individual selection of a diagnostic and treatment program at the oncology hospital in Germany.
- Preparation of a medical program taking into account previously performed diagnostic and treatment procedures.
- Reduced cost of treatment – prices will be reduced due to the lack of additional coefficients for foreign patients.
- Preliminary consultation with a doctor.
- Doctor's appointment on the most suitable dates.
- Preparation of the required documents.
- Provision of insurance against unforeseen complications.
- Monitoring of the medical program at all its stages.
- Control of invoices and return of unspent funds.
- Assistance in buying and forwarding medicines.
- Prompt organization of additional therapeutic and rehabilitation procedures.
- Buying airline tickets, booking apartments or a hotel, meeting at the airport and transfer.
- Communication with the attending physician after returning home.
You can find out more information about the treatment programs in Europe and the cost of medical services by sending your request on the official bookinghealth.com website.
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