Klatskin tumor: treatment of bile duct cancer in Germany

Klatskin tumor is the most common type of cancer, which develops from bile duct cells. It accounts for more than 50% of all cases of pathology. Klatskin tumors most often occur in males. Nowadays, Germany can offer innovative treatment methods that show excellent results even in advanced stages of the disease, which until recently were incurable.

The classical treatment of Klatskin tumor and its disadvantages

Klatskin tumor is a malignant neoplasm, which develops in the biliary confluence. The main treatment method for this pathology is radical surgery. However, standard medical protocols have significant disadvantages:

• Surgery does not always ensure positive results.
• Surgical interventions to remove the Klatskin tumor are technically complex and traumatic, so the recovery of patients takes a long time.
• The tumor often affects the hepatic artery and portal vein, which makes it impossible to perform surgery – only 30% of tumors are considered respectable at the time of diagnosis.
• Oncologists from developing countries usually lack experience in such complex procedures.

Germany is constantly developing and introducing new treatment protocols for Klatskin tumors into medical practice, which show higher survival rates than classical methods.

Modern treatment of Klatskin tumor in Germany

The treatment of Klatskin tumor involves the maximum possible reduction in the volume of malignant tissues, improvement in the quality of life of patients, and prevention of complications. These purposes can be achieved by modern surgical treatment. Should surgery be inadvisable or contraindicated, doctors will use other techniques like hepatic artery embolization, photodynamic therapy, radiation therapy, and systemic drug therapy.

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Surgical treatment of klatskin tumor in Germany

Many patients with Klatskin tumors have a biliary obstruction and mechanical jaundice. The best treatment results can be achieved with radical surgery. Such surgical techniques are not indicated to every person, so German oncologists often use minimally traumatic surgical interventions:

• Endoscopic surgery with bougienage is a surgical restoration of the bile duct patency using endoscopic equipment. In this case, interventions are performed through a small skin incision using special instruments.
• Partial hepatectomy is the removal of a portion of the liver and bile ducts when their lumen is narrowed. It can be performed using laparoscopic equipment with a minimal injury rate. When performing the surgery, the specialists also carry out plastic repairs on large vessels and ducts.
• Bile discharge surgery is a surgical technique for eliminating jaundice. It can be performed several weeks before tumor resection (removal) to reduce the risk of postoperative complications.

After modern surgical operations, the five-year survival rate reaches 40%.

Embolization of metastases of bile duct cancer

To treat inoperable Klatskin tumors, doctors in Germany use hepatic artery embolization. The essence of the procedure is that the vessels supplying the tumor are blocked. The cessation of blood supply contributes to oxygen starvation of cancer cells and their death. For this purpose, the doctors inject emboli (various chemicals) into the arterial lumen. Embolization allows for local control of the disease.

In recent years, embolization has rarely been used in its classical form. Transarterial chemoembolization is usually preferred. This technique involves an additional effect on the tumor with chemotherapy drugs to destroy tumor cells and prevent further progression of cancer. Chemoembolization can reduce the size of the tumor by several times, increase the patient's life expectancy and prevent dangerous complications. At the same time, chemotherapy drugs do not have a toxic effect on the healthy cells, unlike standard chemotherapy.

Chemoembolization in the treatment of bile duct cancer can be performed in several modifications:

• Oily chemoembolization – a suspension or emulsion of a chemotherapy drug with an oil contrast agent (superfluid lipiodol, aethyotrastum, mayodil) is used as emboli. Then the lumen of the hepatic artery is closed.
• Embolization with microspheres – microspheres saturated with chemotherapy drugs are used to block blood vessels. Their diameter is selected according to the caliber of the arteries requiring closure. After the procedure, the drugs are released from the microspheres for a few more weeks and affect the tumor.

The procedure is minimally invasive – it is performed through a small incision in the groin. The doctor inserts a catheter into the arterial bed and reaches the target arteries under X-ray guidance. With the help of a contrast agent, the vessels supplying the tumor with blood are determined, and then emboli are injected into them. The rehabilitation period after such a procedure is minimal, and complications occur rarely.

Some German hospitals offer the innovative procedure called transarterial radioembolization (TARE). It involves the introduction of microspheres containing radioactive substances. The last ones accumulate in the tumor and destroy it with radiation.

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Photodynamic therapy for klatskin tumor treatment in Germany

Photodynamic therapy is used for the treatment of recurrent and inoperable Klatskin tumors in Germany. It can be applied even in the forms of pathology complicated by cholangitis (inflammation of the bile ducts) and impaired liver function.

The method consists in administering a photosensitizer (a substance that increases sensitivity to light) to the patient. It accumulates in tissues with increased metabolism – in cancer cells, and it is then activated by local irradiation of the tumor with the light of a certain wavelength. The influence of light causes chemical reactions in the tissues, which contribute to the formation of reactive oxygen species in the pathological focus. When reacting with various cell structures, reactive oxygen species cause their destruction.

Anti-tumor mechanisms of photodynamic therapy:

• Free radicals directly damage cells.
• Damage to the vessels supplying the tumor and the formation of blood clots – provide up to 60% of the antitumor effect.
• Stimulation of the immune response– due to the destruction of cancer cells, a large number of tumor antigens enter the bloodstream, which activates the immune system.

Photodynamic therapy for bile duct cancer was firstly performed in 1991. The patient underwent seven sessions and lived for more than four years. Since then, new photosensitizers have been developed, which have increased both the effectiveness and safety of the treatment.

According to statistics, patients who receive photodynamic therapy live on average three times longer than those who underwent only bile discharge surgery or biliary stent placement.

In several studies, patients with Klatskin tumors who received photodynamic therapy achieved the same survival rates as patients who underwent partial tumor resection.

Radiation therapy for klatskin tumor (bile duct cancer) treatment in Germany

As a rule, radiation therapy for Klatskin tumor is used after partial tumor resection. It can also be used as the main treatment method for inoperable cancer for local control of pathology and symptomatic therapy (restoring the patency of the bile ducts and eliminating jaundice).

European hospitals use the following methods of radiation therapy:

• Brachytherapy is the intraluminal irradiation of the biliary tract. The doctors insert a thin radioactive wire into the lumen of the bile ducts, which is the source of radiation. It is often combined with external radiation therapy and chemotherapy.
• Irradiation with linear accelerators is the remote method of radiation therapy using state-of-the-art equipment, which allows for targeted delivery of high doses of radiation into the tumor with maximum protection of the healthy tissues.

Unlike standard radiation therapy, these techniques affect only the tumor leaving healthy areas of the body intact. Such an approach allows the doctors to use higher doses of radiation with minimal risk of complications.

Drug therapy for klatskin tumor (bile duct cancer) treatment in Germany

Chemotherapy is the basis for drug therapy of inoperable tumors and prevention after partial tumor removal. Germany uses the latest medicines. They are less toxic than standard ones, and they are more effective. The patients undergo treatment with anticancer drugs in courses, the duration of which depends on the stage of cancer and the characteristics of the tumor.

In some cases, excellent results can be achieved with targeted therapy – treatment with drugs affecting the cellular mechanisms of cancer development. The choice of drug depends on mutations in certain genes. So, if cancer cells contain the FGFR2 (fibroblast growth factor receptor and protein responsible for their growth and division, the doctors prescribe drugs from the group of FGFR2 inhibitors. These drugs block the activity of the protein by inhibiting tumor growth. In addition, they reduce the risk of cancer metastasis.

Targeted therapy can be used for inoperable cancer and in the case of chemotherapy ineffectiveness. The drugs are taken in the form of pills.

Palliative care

At the advanced stages of the disease, the efforts of doctors are mainly aimed at combating jaundice – the main complication of the Klatskin tumor, which worsens the quality of life of patients. It develops in 95% of cases and usually becomes the first symptom of pathology.

Minimally invasive procedures and operations are used to ensure bile outflow. Whenever possible, the specialists perform stent implantation into the bile ducts (introduction of a thin metal tube that keeps the bile duct open). The stent implantation procedure can be performed endoscopically or percutaneously.

Doctors sometimes implant a catheter to drain the accumulated bile from the ducts. Bile is released through it into the external environment and is collected in a special receiver (bag).

The hospitals in Germany also perform surgery to form an anastomosis – a permanent connection that ensures the bile outflow into the small intestine bypassing the area blocked by the tumor. These interventions are performed using a low-traumatic laparoscopic technique, so patients can quickly recover after them.

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Why should you treat the klatskin tumor (bile duct cancer) in Germany?

The successful treatment of the Klatskin tumor requires extensive experience from doctors and access to modern equipment. Therefore it is better to undergo it in specialized German oncology hospitals. All medical facilities here have advanced equipment, and oncologists undergo long training and are constantly introducing new protocols into practice.

Germany annually funds clinical trials and the development of various medical fields. The country shows good survival rates in patients with biliary tract cancer. If standard therapeutic approaches are no longer effective, complementary and alternative treatment methods may be considered.

In addition, the hospitals in Germany elaborate convenient medical programs to treat foreign patients.

German hospitals and price for treatment of klatskin tumor (bile duct cancer)

1. Academic Hospital Brothers of Mercy Munich , Department of General and Abdominal Surgery
2. University Hospital of Ludwig Maximilian University of Munich , Department of General, Abdominal and Transplant Surgery
3. Charite University Hospital Berlin , Department of General, Abdominal and Vascular Surgery
4. University Hospital Marburg UKGM , Department of Abdominal, Thoracic and Vascular Surgery
5. University Hospital RWTH Aachen , Department of Pediatric and Adult General, Abdominal and Transplant Surgery

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How to have treatment of klatskin tumor (bile duct cancer) in German hospitals?

You can undergo high-quality Klatskin tumor treatment in Europe using the services of Booking Health – the official medical tourism organizer.

Booking Health provides the following services:

• Individual selection of a diagnostic and treatment program in a specialized hospital in Germany.
• Preparation of medical programs taking into account previously performed procedures.
• Preliminary consultation with an experienced physician.
• Doctor's appointment on the desired dates.
• The minimum cost of medical services is due to the absence of additional coefficients for foreign patients.
• Preparation of documents.
• Insurance against complications during treatment.
• Monitoring of the treatment at all its stages.
• Monitoring of expenses and return of unspent funds.
• Prompt organization of additional diagnostic and treatment procedures.
• Assistance in buying and forwarding medicines.
• Communication with the attending physician after returning home.
• Buying airline tickets, organizing accommodation in Germany, meeting at the airport, and transferring.

The cost of treatment depends on the size and type of tumor, the general condition of the patient, and other factors. You can get more detailed information about treatment programs and prices by sending your request to the official bookinghealth.com website.

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