Liver cancer
Liver cancer is a dangerous malignant illness with an unfavorable prognosis. This type of cancer basically develops as a result of viral hepatitis or liver cirrhosis. Pathology incidence differs considerably in various countries. In England, USA, and Balkan States liver cancer is as frequent as 2-3 cases per 100,000 persons per year. Meanwhile, the incidence of liver cancer is 10-20 cases per 100,000 persons per year in Asia and Africa.
The Booking Health portal presents 86 German clinics specializing in liver cancer treatment
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Liver cancer – Diagnostics
Deteriorations in the liver function can be detected with the help of biochemical blood test. The following techniques help to diagnose liver cancer:
- Visualization methods (ultrasound, CT) give a chance to detect the tumor-like formation.
- Blood test for the level of α-fetoprotein (Abelian-Tatarinov reaction). Fetoprotein increase indicates liver cancer in 80% of cases.
- Fine-needle biopsy is performed percutaneously. It helps to take the material for cytology.
- Laparoscopy is a surgical method with the intervention into the abdominal cavity. It allows to assess spreading of the pathological process and perform the targeted biopsy for the further histological examination of the biological material.
- Angiography (vascular X-ray examination) is performed to identify the peculiarities of liver blood supply and to assess the tumor resectability.
Blood level of α-fetoprotein is examined for the screening diagnostics. The analysis is performed every six months for the people in the risk group for the liver cancer.
Best clinics for the liver cancer diagnostics in Germany:
Liver cancer – Treatment
Basic method of treatment at a stage 1-3 is a surgical one. Liver tissue with tumor formation is removed. Radical surgical treatment requires removing no less than 2 cm of nearby healthy, unchanged tissues.
Volume of the intervention depends on:
- Size of the tumor
- Spreading of the oncological process
- Morphological type of the tumor
- Location of the liver blood vessels
- Condition of the patient (if he is able to undergo a surgery, and if yes, which volume of the intervention is acceptable)
Surgical treatment includes the following aspects:
- Segmentectomy (the minimal volume of the intervention, carried out in the case of liver cirrhosis, when the patient can’t tolerate extensive resection)
- Hemihepatectomy is a removal of half of the liver
- Expanded hemihepatectomy is a removal of the other liver half fragment
Liver transplantation can be performed in less than 10% of patients with this type of cancer. It does not make sense to carry out this operation in the case of the extensive cancer with a large tumor size, the presence of regional and distant metastases.
The cost of the treatment will vary depending on the method and the hospital:
- The cost of unilateral hepatectomy for liver cancer is between 15,450 EUR and 31,400 EUR.
- The cost of chemotherapy for liver cancer is between 7,300 EUR and 8,000 EUR.
- The cost of percutaneous embolization (coiling) or chemoembolization for liver cancer is between 24,200 EUR and 40,900 EUR.
Liver cancer – Innovative treatment
New treatment techniques are being constantly developed that help to prolong patients’ lives. Many of them have been already implemented into the practice. Some of them are used instead of the surgical intervention if the tumor is inoperable and others are applied as an addition to the surgical treatment.
- Chemoembolization is based on the insertion of cytostatics mixed with the microemboli into the liver artery. It presupposes the influence of the chemicals on the tumor during about 30 days. Procedure allows achieving two-year survival in about 30% of patients even without a surgery.
- Cryosurgery. Tumor is cooled to the low temperature with the help of liquid nitrogen. Cryoablation is applied if tumor size is under 5 cm. Three-year survival of the patients is about 20%.
- Alcoholization of the tumor. Ethanol is injected into the nodules under the ultrasound control. Several sessions are required for the treatment effect. Lethal results are observed in 1.8% of cases while complications arise in 1.5% of cases. Five-year-survival of the patients is 30% which is similar to the surgical treatment.
- Brachytherapy. The main problem of the radiation therapy is its negative influence on the healthy liver tissues. Brachytherapy presupposes implantation of the thin catheters into the tumor tissues. Then, the source of radiation is placed inside. Thus, gamma rays affect only malignant cells, but not the healthy ones.
- Targeted therapy. Angiogenesis inhibitors, like sorafenib and regorafenib, are applied here. They block the growth of the new vessels that feed the tumor. Drugs are prescribed in combination with the surgery and chemoembolization.
- Viral therapy. JX-594 virus is a modified pox virus that destroys the cancerous cells and doesn’t touch the healthy tissues. Medicine called “Pex-Vec” on the basis of JX-594 virus is now investigated in the clinical trials, but it has already showed promising results. It is assumed, that it will be possible to prolong lives of those who suffer from liver cancer for more than a year.
Treatment of stage 4 liver cancer
Doctors do not perform radical operations for the treatment of stage 4 liver cancer. The basis of treatment for stage 4 cancer is systemic therapy.
Systemic chemotherapy has low effectiveness at any stage of liver cancer. However, targeted therapy and immunotherapy provide much better results in the treatment of stage 4 liver cancer.
Targeted therapy for stage 4 cancer is carried out with kinase, VEGF, or VEGFR inhibitors. PD-1 and PD-L1 inhibitors are used for immunotherapy for stage 4 liver cancer. They "turn off" molecules that help cancer cells pretend to be normal, evading attacks from the immune system. In addition to them, CTLA-4 inhibitors, which are also immune checkpoint inhibitors, can be used to treat stage 4 liver cancer.
Best clinics for the liver cancer treatment in Germany:
Marien Hospital Duesseldorf
Helios Hospital Berlin-Buch
University Hospital of Ludwig Maximilian University of Munich
Liver cancer – Rehabilitation
Most patients require rehabilitation after the treatment of both stage one-three and the advanced cancer stages. 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 after 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. First of all, 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 in Germany 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 German clinics, rehabilitation is carried out in a comprehensive manner. The patients are provided with qualitative care here. Doctors' monitoring and conservative treatment allow to avoid complications, which usually happen after treatment of oncological diseases. Psychotherapy, physiotherapy and physical therapy are actively used in Germany.
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 Germany, rehabilitation is carried out with the maximum level of comfort for the patient. A person feels the results quite quickly and it improves his motivation and promotes further recovery.
Best clinics for oncological rehabilitation in Germany:
Authors:
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!
Sources:
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
