Treatment of Neuroendocrine Tumors (NETs) in Germany
Best hospitals and doctors for neuroendocrine tumors (nets) treatment in Germany
Leading hospitals
Cost for treatment
Neuroendocrine tumors (NET) are pathological formations originating from cells of the endocrine or nervous system. NETs most often develop in the intestines, but it can also affect the pancreas, lungs, and other parts of the body. Malignant NETs are rare and are usually diagnosed at an advanced stage of the disease.
Content
- Overview
- Symptoms
- Diagnostics
- Treatment
- Where can I undergo treatment of neuroendocrine tumors in Germany?
- The cost of treatment in Germany
- How can I undergo treatment of neuroendocrine tumors in Germany?
Overview
Neuroendocrine tumors (NETs) are the common term for a diverse group of tumors that develop from neuroendocrine cells. Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with biologically active properties. Neuroendocrine cells have certain secretory characteristics that cause the development of syndromes of overproduction of regulatory peptides, which can lead to the development of the corresponding clinical manifestations.
A neuroendocrine tumor is a formation from neuroendocrine cells located in epithelial tissues. Neuroendocrine cells produce bioactive substances that have various regulatory functions. Since these cells are located in so many body regions, neuroendocrine tumors have a variety of localizations, different growth patterns, clinical manifestations, etc. NETs can be both benign and malignant. The most common of them are insulinoma, gastrinoma, glucagonoma, and neurinoma.
These single cells are located in different organs and are part of humoral regulation, while simultaneously participating in the work of the nervous and hormonal systems. They can absorb amino acids and convert them into substances that transmit nerve impulses (neurotransmitters). Additionally, the same cells produce the following peptide hormones from amino acids.
These hormones bind to special receptors on the surface of cells and stimulate internal biochemical processes. Thus, hormone-like substances produced by the tumor affect all systems of the body. This causes a carcinoid syndrome, i.e. a pathological condition that involves all organs and systems.
The independent degeneration of such elements is very rare; therefore neuroendocrine tumors are rare and poorly studied. The main causes of their development are stress, hormonal abnormalities, exposure to carcinogenic factors (radiation, heavy metals). The most likely locations are the respiratory (25% of cases) and digestive systems (60% of cases). The tumor usually grows slowly and causes various endocrine disorders, depending on the hormones and neurotransmitters produced.
In medicine, neuroendocrine tumors are divided into groups according to their location and the main substances produced. Neuroendocrine tumors are characterized by two main features that also determine the treatment tactics. The first factor is the organ in which the tumor has formed. The second factor is the rate of cell division.
Carcinoids are most commonly found in the lungs and small intestine. The term carcinoid tumor is best used to describe NETs that develop from aerodigestive tissues and are well- or moderately differentiated. NETs with a moderately differentiated grade are also called atypical carcinoids, while poorly differentiated NETs are sometimes considered small cell carcinomas. If the cells of the tumor and the structure of the tumor’s tissue resemble normal cells and tissues, the tumor is called well-differentiated. Carcinoids are always malignant. The most aggressive form of the carcinoid is the large cell carcinoid. It produces serotonin and histamine.
Most neuroendocrine tumors originate in the gastrointestinal tract. These neoplasms are divided into two types depending on the source of the tumor process – whether they start in the intestine or the pancreas. In some patients, the development of the disease is associated with gene mutations.
The most frequent localization of NETs (66% of cases) is the gastrointestinal tract. The predominant locations are the cecum (17.1% of cases) and the rectum (16.3% of cases). About 30% of NETs are found in the bronchopulmonary system.
Neuroendocrine tumors are a rare type of cancer. Now, due to the improvement of diagnostic methods, the number of cases of neuroendocrine tumors detected annually is increasing. The symptoms of the disease are nonspecific, which makes it difficult to diagnose it at the early stage. Therefore, healthcare professionals recommend undergoing preventative examinations, whether symptoms manifest or don’t.
Symptoms
The main symptoms that patients with neuroendocrine tumors may experience are:
- Face blushes
- Losing weight
- Heartburn
- Hypoglycemia
- Violation of food passing
- Diarrhea
- Cholelithiasis
- Erythema
- Hypotension
- Disturbances of the heart rhythm
- Cushing's syndrome
Depending on the localization of NETs, one or another symptom predominates.
With hormonally active neuroendocrine tumors patients may experience:
- Hot flashes, low blood pressure, stool disturbances, abdominal pain
- Loss of appetite, nausea, and diarrhea, weight loss with swelling of the face and limbs
- Increased sweating, trembling of the limbs, blurred vision, confused consciousness, convulsions
- Single and multiple small ulcers in various parts of the gastrointestinal tract
- Diabetes mellitus, stomatitis, glossitis, depression
With hormonally inactive tumors, there are no specific clinical manifestations and complaints, but the risk of malignancy remains.
Neuroendocrine tumors are neoplasms that produce hormones and have features of nervous cells at the same time.
NETs are diagnosed with hormone tests, US scan, CT scan and MRI, biopsy with molecular testing.
NETs include neoplasms of gastrointestinal tract, adrenal glands, lungs, genitourinary tract, and skin.
University Hospital Duesseldorf, University Hospital of Ludwig Maximilian University of Munich, University Hospital Ulm, PAN Clinic Cologne, University Hospital Frankfurt am Main.
Approximate costs are as follows:
Diagnostics
Since NETs can involve different types of cells that perform different functions in the body of patients, symptoms can be very different. In addition to non-specific symptoms such as abdominal pain, constipation, and anemia, specific symptoms such as acromegaly (marked enlargement of the hands, feet, skull, or protruding body parts), Cushing's syndrome, or gastrointestinal ulcers may occur.
In the descending by frequency order, NETs are detected in the appendix (cecum), small intestine, rectum, and bronchi. In the presence of metastases in the liver, the already mentioned carcinoid syndrome often develops. The signs of carcinoid syndrome are redness of the face, diarrhea, narrowing of the bronchi, low blood pressure, etc.
During a visit, a doctor collects anamnesis of patients and conducts examination. After that, various laboratory parameters and the level of hormones in the patients’ blood will be determined. Then imaging methods will be applied, which include X-ray examination, ultrasound scanning, computed or magnetic resonance imaging (CT / MRI), bone scintigraphy, and especially – positron emission tomography (PET).
Often, a tissue sample is taken from the affected organ for further histological and immunohistochemical research during the endoscopic examination.
Laboratory identification of bioactive substances produced by neuroendocrine cells in blood/urine is very important for the diagnosis of neuroendocrine tumors.
Treatment
Recently, oncologists have been increasingly using drugs that destroy neuroendocrine tumor cells by delivering a targeted dose of radiation to them. It is a safe method of treatment of cancer patients, which has proven effectiveness in the treatment of thyroid cancer, neuroendocrine tumors, some brain tumors (meningiomas), and prostate cancer. Such treatment is currently possible with the use of a drug labeled with the isotope Lutetium-177.
Peptide receptor radionuclide therapy is a molecularly targeted procedure for the treatment of patients with neuroendocrine tumors (NETs). In the last decade, this type of therapy has been used in Europe to improve the prognosis in patients with NETs.
Drugs for peptide receptor radionuclide therapy are solutions that are administered intravenously for 10-20 minutes. After that, the doctors monitor patients’ condition for at least 48 hours. Usually, for each injection of the drug, patients are hospitalized for 4-5 days. A total of 3 to 5 treatment cycles are needed, with intervals of 8 weeks. The effectiveness of the drug is checked using scintigraphy combined with computed tomography. During treatment, blood tests are performed; kidney and liver function is monitored.
NET cells usually express receptors for the hormone somatostatin. Peptide receptor radionuclide therapy uses radiopharmaceuticals, in which a radioactive isotope is bound to a tumor-targeting protein (peptide) – an analogue of somatostatin. When radiopharmaceuticals enter the bloodstream via intravenous injection, they bind to somatostatin receptors on the surface of NET cells. Tumor cells absorb the radioactive substance and die.
This therapy is called targeted, since the drug targets tumor cells without causing harm to healthy tissues of the body. Despite the use of radioactive substances, radiation exposure to healthy cells is minimal.
Peptide receptor radionuclide therapy is used to treat NETs that develop in the intestines, lungs, or pancreas, otherwise known as carcinoids or islet cell carcinomas. Peptide receptor radionuclide therapy is indicated for patients with advanced metastatic NETs who are not candidates for surgery and who do not respond well to other treatments.
Currently, peptide receptor radionuclide therapy is not prescribed for children and patients with chronic kidney disease, since there is not enough data on the possible effects of treatment of such patients.
Where can I undergo treatment of neuroendocrine tumors in Germany?
Health tourism is becoming more and more popular these days, as a treatment in Germany often ensures a much better quality of neuroendocrine tumors treatment.
The following hospitals show the best success rates in the treatment of neuroendocrine tumors:
- University Hospital Duesseldorf
- University Hospital of Ludwig Maximilian University of Munich
- University Hospital Ulm
- PAN Clinic Cologne
- University Hospital Frankfurt am Main
You can find more information about the hospitals on the Booking Health website.
The cost of treatment in Germany
The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo neuroendocrine tumors treatment in Germany at an affordable price.
The cost of treatment varies, as the price depends on the hospital, the specifics of the disease, and the complexity of its treatment.
The cost of treatment of neuroendocrine tumors with peptide receptor radionuclide therapy is 13,310-20,790 EUR.
You might want to consider the cost of additional procedures and follow-up care. Therefore, the ultimate cost of treatment in Germany may differ from the initial price.
To make sure that the overall cost of treatment in Germany is suitable for you, contact us by leaving the request on the Booking Health website.
How can I undergo treatment of neuroendocrine tumors in Germany?
It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.
As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the treatment of neuroendocrine tumors in the best hospitals in Germany. We will help you select the right clinic taking into account your wishes for treatment.
We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services are aimed at undergoing treatment of neuroendocrine tumors safely and successfully.
Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko