Treatment of stage 4 rectal cancer in Germany | Booking Health

Treatment of stage 4 rectal cancer in Germany

The article was reviewed by an expert in the field of medicine Prof. Dr. med. Thomas Vogl
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Rectal cancer is a type of colorectal cancer that develops up to 15 cm from the anus. More than 700,000 new cases of this disease are diagnosed annually around the world. The use of innovative treatment methods demonstrates good survival statistics even in patients with advanced stages of pathology, which until recently were considered incurable. Nowadays, the most effective medical care is provided in German hospitals.


  1. Standard treatment of rectal cancer stage 4 and its disadvantages
  2. Advanced treatment methods for stage 4 rectal cancer in German hospitals
  3. Why is it better to undergo treatment in Germany?
  4. How to undergo treatment in European hospitals?

Standard treatment of rectal cancer stage 4 and its disadvantages


Stage 4 rectal cancer is diagnosed when the tumor is no longer localized: the patient has distant metastases or the oncological process spreads along the peritoneum. First-line treatment methods include surgery, chemotherapy, and radiation therapy. However, standard protocols have significant drawbacks. These are as follows:

  • Classical surgical procedures require large incisions in the anterior abdominal wall, which can lead to a high risk of bleeding during surgery.
  • Classical chemotherapy involves the intravenous injection of anticancer drugs, which enter the rectal tissue with the blood flow in a small amount while negatively affecting the healthy tissues of the body.
  • Standard radiation therapy involves total body irradiation, which increases the risk of post-radiation complications.
  • After all these methods, the recovery of the patient's body takes a long time.

The effectiveness of standard treatment can be increased by using higher doses of radiation and chemotherapy as well as by reducing the scope of surgical interventions. However, due to serious health risks for patients, this is impossible in most cases.

Modern medicine already has solutions to these problems, but they are not available in hospitals in developing countries due to poor equipment and lack of experience in specialists.


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Advanced treatment methods for stage 4 rectal cancer in German hospitals


German oncology hospitals use modern protocols, which include improved standard treatment methods for rectal tumors, as well as for the elimination of metastases.

Surgical treatment for rectal cancer stage 4


Surgery is one of the treatment methods for fourth stage rectal cancer. When operating, surgeons can remove the rectum with a primary tumor, pelvic organs if a tumor has spread to them, as well as metastases in the lungs, liver, and abdominal cavity.

To perform surgical procedures as accurately as possible and without the risk of complications, doctors in Germany use the following methods:

  • Laparoscopic resection is the surgical removal of a tumor using miniature endoscopic instruments. Such operations are performed through small skin incisions (usually up to 0.5-1.5 cm). During the intervention, doctors perform all the manipulations while looking at the screen, which allows them to zoom the image by 4 to 10 times.
  • Resection with the da Vinci Surgical System is a technique for removing a tumor with metastases using a state-of-the-art robotic system. The manipulations are performed by a robot whose movements are controlled by a specially trained surgeon. Such an approach reduces the risk of major blood loss during surgery and damage to healthy rectal tissue.

A stage 4 tumor is often inoperable due to its large size. Therefore, patients often require chemotherapy to reduce the size of the neoplasm and metastatic lesions.

After successful operations according to R0 (no residual tumor) classification, the five-year survival rate of patients reaches 50% .

Cytoreductive surgery and HIPEC for rectal cancer stage 4


Doctors in Germany use cytoreductive surgery and follow-up hyperthermic intraperitoneal chemotherapy (HIPEC) for rectal cancer with spread to the abdominal cavity. The essence of the method is that doctors remove all visible tumor foci, and then the abdominal cavity is washed with a solution of chemotherapy drugs heated to 40-44 °C within 1 hour.

This method has the following advantages:

  • Chemotherapy after surgery can destroy the remaining cancer cells, which can provoke the development of a recurrence in the future.
  • The high temperature of chemotherapy drugs improves the penetration of active substances into pathological cells and enhances the antitumor drug's properties.
  • Due to its local action, HIPEC allows using higher concentrations of chemotherapy drugs. It reduces the risk of damage to healthy tissues and the development of systemic complications.
  • Drugs accumulate in tissues and continue to act for several weeks after the procedure.

Hyperthermic intraperitoneal chemotherapy is carried out immediately after surgery. As a rule, it shows excellent results just after a single application, so repeated procedures are not required.


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Treatment of stage 4 rectal cancer in Germany


Radiation therapy for rectal cancer stage 4


After the surgery, radiation therapy is used to destroy tumor foci, which could not be removed surgically. Irradiation is usually required for residual tumors and regional metastases.

In such cases, German oncologists irradiate pathological areas using modern linear accelerators (IMRT, VMAT methods). They can affect tumors of any shape and size with a high dose of ionizing radiation with maximum protection of the healthy areas of the body. In this case, the therapeutic effect is achieved after several sessions, which last only 15-30 minutes.

If surgery is contraindicated for rectal cancer, chemoradiotherapy  can be used. This method combines chemotherapy and radiation therapy. Such treatment reduces the number of cancer cells and increases therapy's anti-tumor effect. The treatment may be sequential, with one method being used first and then another. It is also possible to use both methods at the same time.

It should be noted that sometimes successful chemoradiation therapy can significantly reduce the tumor foci, and the doctor can perform their surgical removal.

Embolization of rectal arteries 


Embolization is a treatment method that involves the use of chemicals to block the arteries supplying the tumor. The specialist began to use it for liver cancer treatment at the end of the twentieth century. Nowadays, various techniques can be used for many other cancers, including malignant rectal tumors.

Doctors in Germany are increasingly using transarterial chemoembolization. It is a type of embolization that is combined with regional chemotherapy. This method involves blocking the arteries with special microspheres saturated with chemotherapeutic agents. Such a therapeutic approach has the following advantages:

  • Reduction of tumor size – blockage of vessels supplying the tumor leads to oxygen starvation of cancer cells and their rapid death.
  • An additional effect of chemotherapy – anticancer drugs influences pathological foci. That way preventing tumor growth and metastatic spreading.
  • The procedure is safe since the arteries are accessed through accurate incisions, which reduces the risk of bleeding and other complications.
  • Rehabilitation is not required – the patient must stay in bed for 24 hours after embolization.

The embolization procedure is widely used before the surgical removal of the tumor. If surgery is not planned, the method can be used for such complications treatment as rectal bleeding. Chemoembolization in the treatment of rectal cancer can be used as an independent method for local control of the tumor.

Hepatic artery embolization


The advanced stages of rectal cancer often spread liver metastases. If they cannot be removed and the possibilities of systemic therapy have been exhausted, doctors use chemoembolization of hepatic artery branches for local control of metastatic foci.

Closing the branches of the hepatic artery has a detrimental effect on tumors and metastases but allows for preserving liver function since healthy liver parenchyma retains the main source of blood supply.

Immunotherapy for rectal cancer stage 4


In the case of colorectal cancer, molecular genetic abnormalities can be detected in tumor cells (in 14% of cases). Malignant cells also contain special protein molecules on their surface, which allow the tumor to evade the immune response. Such neoplasms respond well to immunotherapy.

Immunotherapy involves the usage of checkpoint inhibitors (drugs that block the activity of the PD-1, PD-L1, and CTLA-4 proteins). It helps the patient's immune system detect and attack the tumor, as a result of which the tumor stops growing or even reduces in size.

The drugs are injected intravenously, once every few weeks. The advantage of immunotherapy is good tolerance and the absence of complications. Negative symptoms can develop in the first few days after therapy and they can be easily eliminated with symptomatic therapy.

Targeted therapy for rectal cancer stage 4


Targeted therapy can be used with the availability of some genetic mutations in cancer cells. This treatment method is based on the use of drugs that affect the molecular mechanisms of the tumor.

The following drugs can be used for the treatment of stage four rectal cancer:

  • VEGF inhibitors – are drugs that block the formation of new vessels supplying the tumor.
  • BRAF inhibitors – these are used with the availability of appropriate mutations to destroy cancer cells.
  • EGFR inhibitors (epidermal growth factor blockers) – are used for mutations in the KRAS, NRAS, or BRAF genes to stop tumor growth.
  • Kinase inhibitors – slow down the division of cancer cells and the formation of blood vessels.

Targeted therapy drugs are selected individually, according to the results of molecular genetic tests. The regimen and duration of treatment depend on the spread of the cancer process and the patient's general condition. To achieve the best results, this type of treatment can be combined with chemotherapy.

Palliative care for rectal cancer stage 4


The main complications in stage 4 rectal cancer are intestinal narrowing and obstruction. German hospitals perform endoscopic dilation and stent implantation to eliminate them.

Endoscopic dilation involves the expansion of pathological areas with special endoscopic instruments. The method is low-traumatic and helps eliminate the narrowing of the organ for several months. In the case of complete rectal obstruction, a stent (a hollow tube through which intestinal contents move) is implanted in its lumen.


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Why is it better to undergo treatment in Germany?


More and more patients with IV stage colon cancer undergo treatment in Germany due to the following factors:

  • High quality of medical services – thanks to good funding for medical facilities and scientific research, the oncology sector in Germany develops rapidly.
  • A variety of treatment methods – modern treatment of the tumor and its metastases using the method that is best suited in a particular case.
  • Qualified specialists – German oncologists undergo long training at prestigious universities before admission to medical practice.
  • Excellent equipment – German hospitals always follow developmental trends in the field of oncology and are among the first to the introduction of new technologies into medical practice.
  • Accessibility – Germany has various programs for the treatment of foreign patients.

It is worth noting the rehabilitation period, to which German doctors pay special attention. The treatment is considered successful only when all the body functions are maximally restored. The leading German hospitals with the highest success rates in the treatment of advanced rectal cancer are:

  1. University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology
  2. University Hospital of Ludwig Maximilian University of Munich, Department of Gastroenterology and Hepatology
  3. University Hospital Ulm, Department of Gastroenterology and Hepatology
  4. University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
  5. University Hospital Würzburg, Department of Gastroenterology, Hematology, Oncology, Hepatology, Infectology, Rheumatology and Clinical Immunology

You can find detailed information about doctors and therapeutic methods that are used in these and other hospitals on the Booking Health website.

How to undergo treatment in European hospitals?


You can undergo treatment in the best European hospitals at an affordable price with the help of Booking Health – the world leader in medical tourism.

The employees of Booking Health provide a full range of personalized medical and organizational services. These are as follows:

  • Selection of a suitable medical center for the diagnostics and treatment of stage 4 cancer in Germany.
  • Preparation of a treatment program without repeating medical procedures performed previously.
  • Guaranteed lower average cost of treatment due to the absence of additional coefficients for foreign patients.
  • Preliminary consultation with an experienced specialist.
  • Doctor's appointment on the desired dates.
  • Buying airline tickets, organization of accommodation, interpreting services, and transfers.
  • Preparation of documents, invitations for treatment, and provision of insurance against complications during treatment.
  • Treatment monitoring at all stages.
  • Monitoring of expenses and return of unspent funds.
  • Assistance in buying and forwarding medicines, if necessary.
  • Communication with the attending physician after returning home.

You can find out more information about medical programs and prices by leaving your request on the official website.


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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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