Treatment of Appendix Cancer in Germany
Best hospitals and doctors for appendix cancer treatment in Germany
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Appendix cancer is a rare tumor that often causes acute appendicitis, spreads rapidly through the peritoneum, and metastasizes to the ovaries. This disease is treated in Germany with minimally invasive, laparoscopic surgery. Those patients who have peritoneal carcinomatosis caused by appendix cancer undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. In the advanced stages of appendix cancer, doctors conduct chemotherapy, targeted therapy, and immunotherapy to control the tumor and metastases.
Content
- What is appendix cancer?
- Surgical treatment
- Chemotherapy
- Radiation therapy
- Targeted therapy and immunotherapy
- Why is it worth undergoing treatment in Germany?
Appendix cancer is development of the malignant neoplasm from the tissues of the appendix. Treatment options in Germany include surgery, radiation therapy, and chemotherapy.
These are appendectomy, hemicolectomy, cytoreduction surgery, and removal of the peritoneum in complex cases.
Chemotherapy is administered in the postoperative period. It can be local / intraperitoneal or systemic.
Targeted therapy may also be used in appendix cancer, if a tumor has specific genes or proteins.
Treatment of appendix cancer in Germany with Booking Health includes sparing surgeries, access to novel medications and advanced equipment. The average price of chemotherapy for appendix tumors is 8,900 EUR, the minimum price is 6,900 EUR, and the maximum price is 12,100 EUR.
What is appendix cancer?
Appendix cancer refers to colon cancer and makes up 0.5% of all cases in these tumors. Since the tumor has usually spread to the caecum and colon at the time of diagnosis, doctors can rarely determine for sure that the cancer began in the appendix, and has not spread from nearby intestinal regions.
Therefore, the true prevalence of the disease is unknown. Many cases of appendix cancer are diagnosed as colon cancer. Sometimes, a small tumor, limited to the appendix, is accidentally found in the appendix when it is removed for acute appendicitis. Cancer itself may cause inflammation. It closes the gap between the caecum and the appendix, thereby creating conditions for the stagnation of the contents of the appendix and the development of pathogenic bacterial flora in it.
Histological types:
- adenocarcinoma: mucinous and nonmucinous (not mucus producing);
- neuroendocrine tumors – usually small, rarely spread metastases;
- adenocarcinoid – mixed tumor, rare.
Adenocarcinoma is the same malignant tumor as found in any other parts of the intestine. It grows from the intestine’s mucus-producing glands. Most of these tumors look like solid nodules. Every fourth patient has metastases. In women, they often develop in the ovaries.
In 50% of cases, acute appendicitis is the first manifestation of the disease. The tumor clogs the lumen of the appendix. As a result, the appendix becomes inflamed and surgeons remove it. The neoplasm may be detected in the material.
If it is small and the resection margins are clean, then there is no need for a second operation. The patient is monitored for early detection of recurrences. However, a positive resection margin and a tumor size of 2 cm, require a right hemicolectomy. This is an operation to remove the ascending colon, which is located in the right side of the abdominal cavity. In women, ovary removal is required.
Adenocarcinoid is a mixed tumor that has features of an adenocarcinoma and carcinoid. It is a rare tumor, accounting for 1% of cases. It metastasizes early and has a poor prognosis. The five-year survival rate for patients with this disease is 60%. When performing a surgical intervention, the doctor should remove as many lymph nodes as possible to reduce the risk of regional recurrence.
Carcinoid is a neuroendocrine tumor. In 80% of cases, it is less than 1 cm in diameter. It metastasizes rarely. In 75% of cases, it develops at the apex of the appendix.
Surgical treatment
As a rule, the treatment of appendix cancer begins with surgery.
Appendectomy is an operation to remove the appendix. It is performed only in the early stage of a cancer that has not spread deeper than the mucous membrane. In most cases, an appendectomy for the treatment of patients with appendix cancer is performed laparoscopically: through short abdominal incisions. According to the results from an examination of the surgical material, a decision can be made to repeat a more extensive surgery.
Colectomy is an operation to remove part of the colon. Depending on the stage of the oncology, it can be a partial, segmental colectomy, hemicolectomy, or total colectomy. As a rule, about 25-30% of the intestine is removed. Total colon removal is required only for multiple tumors, for example, in patients with familial adenomatous polyposis.
Types of surgical access:
- open colectomy is a standard operation performed through a large abdominal incision;
- laparoscopic colectomy is a more sparing intervention, which is performed through short incisions, with long, thin instruments.
For a surgeon with sufficient experience, laparoscopic surgery provides the same oncological results as open interventions. Therefore, it is usually the preferred method, to perform the treatment of appendix cancer in Germany with this technique, because laparoscopy provides many advantages compared to laparotomy: less trauma, lower risk of complications, reduced recovery period, less time in the hospital, better tolerance of the postoperative period, and the absence of large scars on the abdomen.
Lymph node dissection is a mandatory stage of a surgical intervention. The doctor removes the lymph nodes to examine them for cancer cells and reduce the risk of regional recurrence. Regional for two-thirds of the appendix near the caecum, are the lymph nodes at the base of the process and along the right half of the colon. When the distal third (at the end of the appendix) is affected, metastasis occurs in the lymph nodes of its mesentery. For adequate staging, the doctor must remove at least 12 lymph nodes.
Oophorectomy is a surgical procedure that involves the removal of the ovaries. It is performed in most female patients, as it is considered mandatory when the tumor size is more than 2 cm. Appendix cancer often metastasizes to the ovaries. To prevent the recurrence of the disease, it is better to remove the ovaries immediately. This procedure can also be performed laparoscopically. After ovary removal in women, menopause occurs. However, in most cases, cancer develops at an age when the ovaries cease to function anyway, so their removal does not cause significant damage to the woman's health. In the case of ovary removal before the age of 45, the patient can undergo hormone replacement therapy, which compensates for the hormone deficiency.
Colonic stenting is performed in a case of tumor obstruction. It is used as preparation for radical surgical treatment. After the patient's condition improves, doctors perform a colectomy.
Emergency colectomy is performed in case of complications. Perforation of the appendix causes peritonitis. In addition, some operations are performed due to colon obstruction. Such interventions are usually open. In addition, the doctor cannot immediately suture the ends of the intestine to restore the patency of the digestive tract. Therefore, a colostomy is made on the skin of the abdomen. Some time later, after the patient's condition stabilizes, the second operation is performed, during which, the doctor sutures the ends of the intestine together, restoring the possibility of natural defecation.
Cytoreductive surgery is a surgical intervention that is performed in the case of tumor spread through the peritoneum. In appendix cancer, the likelihood of peritoneal carcinomatosis is higher than in any other localization of colon cancer. The risk of tumor spread along the peritoneum is at least 30%, and, according to some authors, it reaches up to 100%. When performing the operation, doctors remove the part of the intestine with the primary tumor, as well as all visible tumor foci. In Germany, cytoreductive surgery is often followed by hyperthermic intraperitoneal chemotherapy, in order to reduce the risk of recurrence. The combination of these methods is very effective: even at an advanced stage of appendix cancer, a five-year survival rate of patients is achieved in 60-65% of cases. Some patients are completely cured of cancer.
Chemotherapy
Chemotherapy can be used in the following cases:
- before surgery, to reduce the tumor size (very rare);
- after surgery, to reduce the risk of recurrence (stage 3 and above, sometimes stage 2 in cases with a high risk of recurrence);
- at an advanced stage of cancer.
Chemotherapy can be not only systemic, but also local and regional. All of these methods can be used for the treatment for appendix cancer.
Intraperitoneal chemotherapy is a type of local chemotherapy. Doctors heat a solution of cytostatics and wash the abdominal cavity with it for 1-1.5 hours to destroy all the cancer cells. This procedure is done immediately after the completion of the cytoreductive operation. Chemotherapy drugs penetrate to a depth of 2-3 mm and destroy tumor foci. However, systemic side effects are extremely rare. Although the concentration of chemotherapy agents is 10-20 times higher than those used for systemic chemotherapy, the drugs do not enter the systemic circulation in large quantities due to the presence of the peritoneal-plasma barrier.
Hepatic artery chemoembolization is used in a case of liver metastases. Doctors clog the branches of the hepatic artery that supply the metastatic tumor with emboli containing chemotherapy agents. As a result, the tumor dies due to the cessation of blood supply and drug damage.
Radiation therapy
Irradiation is rarely used for the treatment of patients with appendix cancer. It can be performed in the following cases:
- before surgery, to reduce the tumor size (very rare);
- after surgery, if the risk of recurrence is assessed as high;
- during surgery, some hospitals perform intraoperative radiation therapy;
- as the main method of local tumor control in patients with medical contraindications to surgery;
- for symptom relief in the advanced stage of the disease;
- for distant metastasis suppression, most often in the bones, lungs or brain (if metastases appear elsewhere, other methods are usually used: surgery, ablation, chemoembolization).
Targeted therapy and immunotherapy
In advanced types of cancer, doctors in Germany provide treatment with the following drugs:
- vascular endothelial growth factor (VEGF) inhibitors block the growth of new vessels, which are necessary to meet the metabolic needs of the growing tumor;
- epidermal growth factor receptor (EGFR) inhibitors slow down the division of cancer cells and reduce the rate of tumor progression;
- BRAF inhibitors are used in patients with mutations in the corresponding genes;
- kinase inhibitors reduce the growth rate of the tumor and worsen its blood supply;
- PD-1 and CTLA-4 inhibitors enhance antitumor immunity, by reducing the ability of the tumor to evade the immune response.
Drug therapy in Germany is selected individually, based on molecular genetic tests. Qualitatively selected treatment for patients with advanced cancer allows doctors to control a malignant tumor for several years.
Why is it worth undergoing treatment in Germany?
There are a few reasons for you to undergo appendix cancer treatment in Germany:
- minimally invasive laparoscopic surgery instead of open surgical interventions through an abdominal incision;
- quick recovery and minimal risk of complications;
- well-performed lymph node dissection – many patients can avoid postoperative chemotherapy;
- successful treatment of even the advanced stages of appendix cancer: with the help of cytoreductive and combined operations and hyperthermic intraperitoneal chemotherapy;
- the use of modern drugs for the advanced stages of cancer: not only chemotherapy, but also individually selected targeted therapy and immunotherapy.
To undergo treatment of appendix cancer in Germany, please use the Booking Health service. On our website you have the opportunity to get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals and book a medical care program at a favorable price. The treatment will be easier and faster for you, and the cost of treatment in Germany will be lower. The average price of appendiceal cancer diagnosis in Germany is 4,300 EUR, the minimum price is 3,800 EUR, and the maximum price is 5,700 EUR. If it comes to a treatment program, cost of the examination is included. The average treatment costs are as follows:
- Surgical treatment of appendix cancer with minimally invasive laparoscopic right hemicolectomy – 19,300 EUR
- Treatment of appendix cancer with chemotherapy – 8,700 EUR
- Treatment of neuroendocrine tumor (NET) of the appendix with chemotherapy – 8,500 EUR
- Treatment of neuroendocrine tumor (NET) of the appendix with Lutetium-177-DOTATATE – 18,700 EUR
You are welcome to leave your request on the Booking Health website. Our employee will contact you, consult with you, and answer all questions. We will take care of the organization of your trip abroad. We will provide the following benefits for you:
- We will select the best German hospital, whose doctors specialize in the treatment of appendix cancer and achieve the best results.
- We will help you to overcome the language barrier and establish your communication with the doctor at the German hospital.
- We will reduce the waiting period for diagnostics and treatment, and you will receive medical care on the most suitable dates for you.
- We will reduce the price. The cost of treatment in Germany will be lower than usual due to the lack of overpricing and coefficients for foreign patients.
- Our specialists will solve any organizational issues: paperwork, transfers from the airport to the German hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to undergo any previously performed diagnostic procedures.
- We will stay in contact with the German hospital after the completion of your treatment.
- We will organize additional diagnostics and treatment, if necessary.
- We will buy medicines in the other country and forward them to your native country.
While the best specialists in the world take care of your health, the Booking Health staff will help you to reduce the cost of treatment in Germany and take care of all your travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. 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!
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