Colon (bowel) cancer
Bowel cancer (colon cancer) is a malignant disease that is most common in the Western countries. Incidence of this disease is 15-20 cases per 100 thousands population per year. Thanks to the development of the new methods of treatment it became possible to achieve a significant reduction in the mortality of patients from this pathology in recent years. Stage 4 colon cancer requires special medical attention and individually tailored treatments, as the survival rate by age and stage demonstrate not that promising estimates.
The Booking Health portal presents 97 German clinics specializing in colon (bowel) cancer treatment
Show all clinicsThese are surgeries and HIPEC, ablation, cryotherapy, embolization and chemoembolization of metastases, chemotherapy, targeted therapy, and immunotherapy. Treatment scheme is elaborated individually.
The disease is typically not curable, but modern therapies can prolong life and improve its quality.
The 5-year survival rate is about 14%, provided a person receives specialized medical care.
These are University Hospital Duesseldorf, University Hospital of Ludwig Maximilian University of Munich, and University Hospital Ulm. You will find the full list on the Booking Health website.
Stage 4 colon (bowel) cancer – Symptoms
Clinical manifestations of stage four colorectal cancer can vary depending on the location of the initial neoplasm and the affected distant organs. However, most people complain of the following manifestations:
- Persistent abdominal discomfort or pain. This occurs due to the pressure a growing tumor is causing or blockage in the gastrointestinal tract. The pain may be crampy, dull, or sharp, and may be accompanied by bloating or a feeling of fullness.
- Unexplained weight loss. You may lose weight without trying, which can be a sign that cancer influences metabolism: cancer cells use your body's resources or the process changes your appetite or digestion.
- Fatigue. You may feel unusually tired or weak, even if you have been getting enough rest. This occurs due to tumor toxins or from the natural immune response to oncology.
- Rectal bleeding. You notice blood on toilet paper or in your stool. This occurs due to the cancerous tumor causing damage to the lining of the colon or rectum.
- Change in bowel habits. You may experience a change in the frequency, consistency, or shape of your bowel movements. You may also feel that you cannot completely empty your bowels. This can occur due to the cancerous tumor blocking or narrowing the colon or rectum.
- Nausea or vomiting. You may feel queasy or sick to your stomach, which can lead to vomiting. This occurs due to the cancerous tumor causing blockage or irritation in the digestive tract.
- Jaundice. You may develop yellowing of the skin and whites of the eyes when the process spreads to the liver. This can occur due to the cancerous tumor blocking or damaging the bile ducts in the liver.
Please note that these clinical signs can also be manifestations of other conditions, such as inflammatory bowel disease or infections. However, if you experience any of these symptoms, especially if they persist or worsen over time, you must seek medical attention. Symptoms of the cancer are the same as in other intestinal diseases of non-tumor origin. Therefore, it is only possible to establish a diagnosis after the instrumental examinations.
Stage 4 colon (bowel) cancer – Diagnostics
Examinations for colon cancer stage 4 investigate not only the abdomen and gastrointestinal tract, but also the whole body, as oncologists need to look for metastases everywhere. Plan of diagnostics in suspected fourth stage cancer includes:
- Medical history taking. The doctor will ask you in detail about family history of oncology and previous treatments (if any).
- Fecal occult blood test (FOBT) to detect even minimal bleeding and blood tests, including the ones for the oncomarkers (carcinoembryonic antigen).
- Barium enema, or irrigography, is an X-ray method of examination with contrast. During the barium enema procedure doctors assess the state of the intestine in real time, and during the irrigography a picture is taken. Before this, the patient undergoes an enema with contrast medium (barium sulfate). Using these methods the doctor can estimate the shape and size of the tumor, its location and possible complications (germination in the bladder, small intestine, and vagina).
- Colonoscopy is held after the barium enema. This endoscopic diagnostic method involves insertion of an instrument into the colon. In addition to the visual evaluation of the malformation, a doctor is able to take a biopsy for further cytological and histological examination.
- Ultrasound examination, CT, MRI are non-invasive diagnostic methods that help to detect a tumor metastasizes (spreads) to the lungs, liver, and other organs.
- Laparoscopy is an invasive technique with the penetration into the abdominal cavity. The procedure is carried out to assess the spreading of tumor and metastases detection.
Once the diagnosis is confirmed, additional tests are administered. These are molecular tests for mutations in KRAS, NRAS, and BRAF genes, which are necessary for planning targeted therapies. Other investigations are MSI and MMR testing, which are necessary for planning immunotherapy.
Best clinics for the colon (bowel) cancer diagnostics in Germany:
Stage 4 colon (bowel) cancer – Treatment
The main treatment method for the early-stage colon (bowel) cancer is surgery. It is a chance to prolong the patient’s life considerably. When it comes to the 4th stage disease, surgical interventions are aimed at destroying metastatic foci and relieving symptoms, but not at curing cancer. Some of them are means of palliative care.
Bowel resection implies removing the tumor with the part of the intestine. It has to be added that distal and proximal edges of the cut-off should be far enough from the neoplasm and not contain atypical cells after the histological study. In this case, the risk of recurrent colon cancer is significantly reduced. Together with the large intestine fragment all regional lymph nodes are also removed.
Extended bowel resection. It is used in the case of germination of the tumor into other organs and tissues. In course of the operation intestinal, stomach, liver, and bladder parts can be removed, depending on the location and extent of cancer process.
HIPEC (hyperthermic intraperitoneal chemotherapy) is performed intraoperatively. The indication is peritoneal carcinomatosis. The procedure involves rinsing the abdomen with heated chemotherapy drugs solution. HIPEC destroys microscopic metastases and remnants of the tumor, thus reducing the risk of relapse. The technique is available in a limited number of hospitals.
Chemotherapy is used before (neoadjuvant chemotherapy) surgery to shrink a tumor and metastases and make the procedure more successful. When being used after a surgery (adjuvant chemotherapy), drugs kill the remaining malignant cells and contribute to better survival rates. Radiation therapy can be used with the same purposes in specific tumor localizations.
The costs for the treatment in the specialized cancer centers in Germany are as follows:
- The cost of da Vinci surgery for colon cancer ranges between 20,400 EUR and 40,700 EUR.
- The cost of chemotherapy for colon cancer ranges between 6,950 EUR and 12,100 EUR.
- The cost of cytoreductive surgery and HIPEC for colon cancer ranges between 51,900 EUR and 92,400 EUR.
Stage 4 colon (bowel) cancer – Innovative treatment
In addition to the techniques used in the past decades, new technologies and products are actively implemented into treating stage 4 colon cancer. They help to treat bowel cancer more effectively.
Laparoscopic bowel resection. Earlier operations on malignant tumors of the colon were performed only with the use of laparotomy, but now many types of tumors can be removed with laparoscopic techniques. The intervention is carried out through several incisions of the minimum size. This greatly facilitates the postoperative period with the same operation effectiveness.
Robot-assisted operations are carried out with the help of robotic technology. Such laparoscopic bowel resection is performed more accurately, with less traumatization, lower lethality, easier and more rapid postoperative recovery of the patient. Despite the higher cost, it has undoubted advantages.
Minimally invasive interventions for liver metastases. These include laser ablation of metastatic foci, cryotherapy with freezing them, embolization and chemoembolization of the hepatic artery.
Immune checkpoint inhibitors are a new group of drugs for immunotherapy of colon cancer. Checkpoints are the molecules on the surface of cells, including cancer cells. They make it clear to the immune system that these cells must not be subjected to its influence. Checkpoint inhibitors "hide" the signaling molecules and the immune system begins to fight the tumor.
A vaccine against cancer is another method of immunotherapy, which lowers the risk of colon cancer recurrence after the surgery. The vaccine enhances human immune system activity against tumor cells.
Immunotherapy for colon cancer
Immunotherapy for colon cancer can rarely be used in standard cases. It is sometimes resorted to at stage 4 of cancer. The main immunotherapy drugs are immune checkpoint inhibitors. They prevent the tumor from evading immune attacks. PD-1 inhibitors are usually prescribed. In addition to them, CTLA-4 inhibitors can be used. Both groups of drugs are prescribed for high microsatellite instability levels or changes in the MMR gene.
Dendritic cells for colon cancer
One of the options for immunotherapy for colorectal cancer is dendritic cell therapy. Dendritic cells (DCs) are needed to disassemble antigens into fragments and present them to T cells in parts because T cells cannot recognize whole antigens. The principle of therapy is based on the fact that monocytes are taken from human blood, some substances are added for their maturation into DCs, they are treated with tumor antigens, and they are injected into the body. Following vaccination for colon cancer, the immune system's response is enhanced.
Typically, colon cancer treatment with dendritic cells is used at an advanced stage, and vaccination after surgery is also possible. These treatments are currently considered experimental, with dozens of dendritic cell-based vaccines currently in clinical trials.
We also recommend that you watch the video on our YouTube channel "Booking Health", where the leading specialists of the specialized clinic talk about the advantages and peculiarities of dendritic cell therapy.
Best clinics for the colon (bowel) cancer treatment in Germany:
Stage 4 colon (bowel) cancer – Rehabilitation
After treatment of complex oncological diseases most patients require rehabilitation. It includes the following aspects:
- Prevention of complications that may occur as a result of treatment. It can be pneumonia, lymphostasis, thromboembolic or infectious complications.
- Restoration of general health. The elimination of the consequences of surgeries and chemotherapy is carried out. The functions of internal organs are restored with the help of various medical and rehabilitation measures.
- Restoration of occupation. A person must not just stay alive. He must have physical and intellectual capabilities, which are sufficient for employment.
- Psychological support. Firstly, it is required for patients, whose occupational performance was harmed because of the disease. Patients with deterioration of appearance also will benefit from psychological help.
- Restoration of appearance. If necessary, you can use surgical and other methods to restore appearance defects caused by cancer. For example, to carry out the reconstruction of the breast.
- Social and domestic rehabilitation. A person with reduced workability is trained to act in the society and perform everyday tasks in new conditions.
In European clinics, rehabilitation is carried out in a comprehensive manner. The patients are provided with qualitative care here. Doctors' monitoring and conservative treatment allow avoiding complications, which usually happen after treatment of oncological diseases. Psychotherapy, physiotherapy and physical therapy are actively used in Europe.
Specialists in different medical spheres take part in the rehabilitation process. These are massage therapists, speech therapists, specialists in physiotherapy exercises, physiotherapists. Social and occupational therapy is carried out, as well. If necessary, people are taught how to eat properly, take care of a colostomy or urostomy, etc.
In European centers, rehabilitation is carried out with the maximum level of comfort for the patient. Being treated abroad, a person feels the results quite quickly, and it improves his motivation and promotes further recovery, which justifies somewhat higher prices for medical services.
Best clinics for oncological rehabilitation in Germany:
Author:
The article was edited by medical expert, board certified Dr. Nadezhda Ivanisova. 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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The cost of services includes
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc
