Neuroendocrine Tumor (NET) of the Pancreas — Embolization or Chemoembolization: treatment in the Best Hospitals of Germany
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Pancreatic Cancer Treatment in Germany
- Pancreatic cancer
- Diagnosis by ERCP and biopsy under CT guidance
- Chemotherapy and radiation therapy
- ERCP and bougienage with stenting
- Chemotherapy
- Whipple procedure (pancreaticoduodenectomy)
- Segmental pancreas resection
- Proton Therapy
- Embolization or chemoembolization
- Therapy with Lutetium-177-DOTATATE (Lu-177)
Department of Interventional Radiology
The Department of Interventional Radiology offers the full range of imaging examinations, as well as innovative image-guided minimally invasive techniques for the treatment of tumors, vascular diseases and internal pathologies (for example, CT, MRI, PET-CT, SPECT). The department's doctors have deep knowledge and colossal experience in the field of interventional radiological methods of treatment, which represent an excellent alternative to open surgical interventions. Despite the high level of technical equipment and the presence of advanced computerized systems, the focus is always on the person with his individual needs. Compliance with current clinical protocols and high professionalism of the department's specialists contribute to the successful clinical practice, as well as the reputability of the department among the best medical facilities of this kind in Germany.
Department of Interventional Radiology and Neuroradiology
The Department of Interventional Radiology and Neuroradiology offers a full range of advanced imaging diagnostics and minimally invasive treatments on both an inpatient and outpatient basis. The department has state-of-the-art medical equipment for imaging tests such as X-ray, computed tomography, magnetic resonance imaging, digital subtraction angiography, and mammography. The medical facility also performs many highly effective interventional therapeutic procedures under image guidance, which in many cases allow patients to avoid traumatic open surgery. For example, the department successfully performs local fibrinolysis, thrombectomy, percutaneous transluminal angioplasty, hemostasis, transarterial chemoembolization, uterine artery embolization, and other procedures. The department's neuroradiologists specialize in brain and spinal cord imaging and the treatment of central nervous system disorders. Interventional neuroradiology focuses on the treatment of carotid artery stenosis, brain aneurysms, arteriovenous malformations, dural fistulas, subdural hematomas, brain tumors, skull base and spinal tumors, and chronic back pain. The department's medical team has extensive clinical experience in their areas of expertise. The specialists are guided by the recommendations of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society for Neuroradiology (DGNR), which helps to achieve the best results.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology is one of the best institutions of its kind in Germany and offers patients the full range of radiological studies and imaging-guided minimally invasive therapy. The department’s scope of tasks also includes imaging diagnostics in children of all age groups, detection and invasive treatment of cerebral vascular pathology (neuroradiology). Patient care is provided both on an inpatient and outpatient basis.
Department of Interventional Radiology
The Department of Interventional Radiology specializes in the full range of minimally invasive image-guided interventions for diagnostic and therapeutic purposes. Diagnostic interventional procedures allow obtaining tissue samples for further laboratory tests. Most minimally invasive interventional procedures are performed for the treatment of vascular obstruction or stenosis, as well as for tumor destruction. The surgeon inserts special catheters and/or probes through small skin punctures. All surgical procedures are performed under image guidance – X-ray, digital subtraction angiography, ultrasound, CT, MRI. The specialist can clearly see all the anatomical structures and a pathological focus, thanks to which he accurately controls the delivery of the catheter to the required site and all subsequent manipulations. It is worth noting that the department was awarded the quality certificate of the German Society for Interventional Radiology (DeGIR) in 2018, which guarantees effective treatment in accordance with modern medical standards. The department's doctors have the necessary skills and qualifications, which allow them to select the best treatment option for each patient and ensure its successful conduction.
Department of Interventional Neuroradiology
The Department of Interventional Neuroradiology offers the full range of services in the areas of its specialization. The medical facility provides imaging diagnostics and low-traumatic image-guided interventional treatment of nervous system diseases. The department's specialists have rich experience and exceptional professional skills in the field of interventional procedures for acute and chronic vascular diseases, such as ischemic strokes, brain hemorrhages, cerebral artery stenosis, brain aneurysms, and vascular malformations. The department's neuroradiologists cooperate closely with neurologists and neurosurgeons so that each patient receives an optimal treatment regimen based on the expert opinions of the specialists. The department's medical team has state-of-the-art computed tomography (CT), magnetic resonance imaging (MRI), and MR angiography systems that are actively used for diagnosing patients and therapeutic procedures. Medical care is provided in compliance with current clinical protocols. The department also offers many outpatient medical services, which is an advantage for many patients.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of medical services in these fields. In order to ensure the most accurate and reliable diagnostics, the department has state-of-the-art systems for CT, MRI, PET, ultrasound and X-ray examinations, as well as PET-CT and SPECT-CT hybrid examinations. The department specializes in interventional radiology, namely, imaging-guided therapy. It performs all vascular (for example, vascular recanalization) and non-vascular imaging-guided interventions (for example, tumor ablation). The department is one of the largest and leading medical facilities of this kind in Europe.
Department of Interventional Radiology
The Department of Interventional Radiology offers a full range of modern imaging tests and image-guided therapeutic procedures. The department performs imaging examinations for patients from all departments of the University Hospital Oldenburg: X-ray, computed tomography, magnetic resonance imaging, sonography, mammography, and angiography; diagnostic examinations are performed on an outpatient basis. To ensure accurate diagnosis and effective treatment, the department has state-of-the-art medical equipment, including a 64-slice spiral CT scanner, two high-performance 1.5 Tesla MRI scanners, advanced equipment for digital subtraction angiography, pulsed fluoroscopy, and many other devices. The department's team of physicians also specializes in image-guided therapeutic interventional procedures – the treatment of vascular stenoses and occlusions, malignant tumors, and chronic back pain. Therapeutic manipulations are often performed on an outpatient basis. The department adheres strictly to radiation safety standards, so patients can expect highly effective and safe treatment.
Department of Adult and Pediatric Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Interventional Radiology, Neuroradiology specializes in modern imaging examinations and minimally traumatic image-guided interventional procedures. Of particular interest to the department's experienced medical team is individualized minimally invasive therapy for cancer and the treatment of pain syndromes and vascular pathologies. The medical facility has state-of-the-art equipment for X-ray scanning, angiography, ultrasound scanning, CT, MRI, and PET/MRI. The diagnostic devices are adapted for children, including newborns. During examinations and treatment, the department's specialists strictly meet radiation protection standards. As for treatment, special attention in clinical practice is paid to interventional procedures for vascular diseases and malignant tumors. These procedures are performed using catheter-based techniques under CT, MRI, or angiography guidance. Despite the low trauma rate of interventional manipulations, their effectiveness is comparable to full-fledged surgery. The medical facility cooperates closely with other departments at the hospital, thus providing comprehensive medical care at the highest level of university medicine. The department's successful clinical practice has been recognized by prestigious quality certificates, including the ClarZert certificate and certificates from the German Cancer Society (DKG) and the German Radiological Society (DRG).
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology provides the full range of services in these fields and specializes in conducting radiologic examinations, high-intensity focused ultrasound (HIFU) therapy, vascular, oncological, orthopedic and urologic interventions. The department includes specialized Sections for Gynecologic, Pediatric and Orthopedic Radiology.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology offers the full range of modern radiological examinations and minimally invasive imaging-guided treatment of various diseases. Most often, radiologists have to deal with the diagnostics and therapy of tumors, inflammatory processes, injuries, pathologies of the heart and vascular diseases. The combination of advanced medical technologies and high professionalism of the doctors working in the department are the key to the successful treatment results.
Department of Adult and Pediatric Interventional Radiology
The Department of Adult and Pediatric Interventional Radiology provides the full range of medical services in the area of its specialization. The department offers modern diagnostic rooms with advanced equipment for imaging examinations for patients with suspected cancer, diseases of the cardiovascular system, thorax, abdominal organs, musculoskeletal system, and breast diseases. The department's diagnostic systems are adapted for examining children of different age groups. The medical facility also offers many therapeutic services, the most popular of which include MRI-guided treatment of uterine fibroids with high-intensity focused ultrasound (HIFU) and uterine artery embolization, prostate adenoma treatment with prostate artery embolization, tumor treatment with brachytherapy, percutaneous radiofrequency ablation, percutaneous microwave ablation, and transarterial chemoembolization. The doctors working at the medical facility also have rich experience in the interventional treatment of vascular pathologies and arteriovenous malformations. The department has an excellent reputation and regularly diagnoses and treats patients not only from Germany but also from other countries in the world.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology offers the full range of services in these medical fields. Here patients can undergo all modern imaging diagnostic studies and therapeutic procedures, the quality of which corresponds to high international standards. The department also specializes in conducting radiological studies in children and adolescents. The cutting-edge technical equipment and the rich clinical experience of doctors contribute to the successful work of the department.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of modern diagnostic and therapeutic procedures in this field. For this purpose, it has advanced medical equipment: magnetic resonance imaging (MRI), multispiral computed tomography (CT), duplex sonography and digital X-ray, fluoroscopy, etc. In the field of interventional radiology, the focus is on the treatment of vascular diseases, for example, the doctors of the department conduct special measures for dilating the vessels in peripheral arterial occlusive disease and closing the vessels in complicated bleedings. Also, the range of services in this field is complemented by the installation of drainage and port systems, punctures, and special percutaneous methods for tumor treatment.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology offers the full range of services in these fields. It conducts all types of modern imaging studies: sonography, digital X-ray, angiography, multilayer computed tomography and conventional MRI, positron emission tomography (PET/CT), etc. The department also specializes in minimally invasive treatment of various tumors, vascular pathology (obstruction and vascular stenosis). The Section of Experimental Radiology is engaged in active research to optimize existing methods and develop new ones.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of services in these medical fields. It conducts all modern radiological examinations and imaging-guided minimally invasive interventions for the treatment of various benign and malignant diseases. A feature of the department is imaging diagnostics in children and adolescents. There are specially adapted devices with minimal irradiation for this purpose.
Department of Interventional Radiology
The Department of Interventional Radiology provides the full range of medical services in the area of its specialization. The team of the department's doctors specializes in diagnostic and therapeutic image-guided interventional procedures. The doctors have at their disposal the most advanced imaging devices, including X-ray systems, ultrasound devices, equipment for computed tomography and magnetic resonance imaging. In most cases, the department's specialists perform interventions on the vessels, and therefore doctors from the Department of Vascular Surgery are often involved in the therapeutic process. The use of state-of-the-art equipment allows the patients to get rid of pathological changes in the vessels of any part of the body, excluding open invasive surgery with its high risks. The department's medical staff has excellent qualifications and vast clinical experience, so patients confidently trust their health to real professionals.
Neuroendocrine tumors (NETs) are neoplasms developing from cells capable of producing hormones or biologically active amines. The pancreas is one of the primary locations of this group of tumors. NETs come in varying grades. While benign diseases can usually be cured with surgery, malignant tumors are often detected at an unresectable stage. In this case, chemoembolization is used as a minimally invasive procedure for local control of NETs.
Content
- Types of pancreatic NETs
- How is NET of the pancreas treated?
- What are embolization and chemoembolization?
- When can chemoembolization be used for pancreatic NETs?
- How is chemoembolization for NETs performed?
- Where can I undergo treatment?
Types of pancreatic NETs
Pancreatic neuroendocrine tumors account for up to 5% of all neoplasms of this organ and up to 7% of NETs of various localizations. About 60% of them are non-functional. The remaining 40% of tumors produce hormones such as insulin, gastrin, glucagon, somatostatin, vasoactive intestinal peptide, and calcitonin.
According to the 2019 WHO classification, pancreatic NETs are categorized as follows:
- Highly differentiated: G1, G2, or G3, indicating low, intermediate, or high grades
- Poorly differentiated: small-cell or large-cell neuroendocrine cancer
- MINEN: mixed tumors in which the neuroendocrine component accounts for more than 30% of the neoplasms
How is NET of the pancreas treated?
After the diagnosis by ERCP and biopsy during ERCP and the use of radiation examinations, the therapeutic tactics are determined. The main neuroendocrine tumor treatment in Germany is surgery. The choice of surgical intervention depends on the grade of NET, stage, location, and size of the tumor, as well as the presence of large blood vessels nearby.
Possible surgical interventions include:
- Simple enucleation (tumor removal)
- Segmental pancreas resection
- Whipple procedure (pancreaticoduodenectomy)
- Distal pancreatectomy, possibly with splenectomy
- Total pancreatectomy
For tumors larger than 2 cm, a mandatory stage of any operation in pancreatic cancer treatment in Germany is lymph node dissection, the surgical removal of regional lymph nodes.
Malignant or intermediate pancreatic tumors can be treated with somatostatin analogues, chemotherapy, radiation therapy (including proton therapy), and therapy with Lutetium-177-DOTATATE. Embolization and chemoembolization are used for local tumor control. In advanced stages, many patients require palliative procedures such as bougienage with stenting.
What are embolization and chemoembolization?
In some patients, tumor shrinkage and long-term control of tumor growth can be achieved using a minimally invasive procedure called chemoembolization.
Embolization is a procedure to block the arteries that supply blood to the tumor. The neoplasm thus does not receive oxygen, so the cancer cells die.
Embolization may be supplemented with regional chemotherapy. In this case, the technique is called chemoembolization. The procedure is also supplemented with regional radiation therapy by introducing radioactive materials into the arteries supplying the tumor. In this case, it is called radioembolization.
Traditionally, drugs and emboli are used separately for chemoembolization and radioembolization. However, in recent years, microspheres saturated with chemotherapy drugs or radioactive materials have become more popular. They provide a more expressed cytoreductive (tumor-shrinking) effect.
When can chemoembolization be used for pancreatic NETs?
Transarterial pancreatic tumor embolization in Germany is not the primary treatment option. Tumors are removed using surgical techniques whenever possible.
But with malignant tumors, up to 80% of patients have an unresectable stage at the time of treatment. In this case, chemoembolization is a good option for local tumor control because radiation therapy for pancreatic tumor treatment is not very effective.
The main goal of chemoembolization is, therefore, local control of unresectable tumors. Limitations for this procedure are considered to be the branching of the pancreatic arteries with multiple collateral blood supply pathways to the tumor, as well as hypovascularized (poor blood flow) neoplasms. In these cases, chemoembolization may not be effective.
Other areas of application of chemoembolization are as follows:
- It can be used as a preoperative procedure to shrink the size of the tumor and reduce blood loss during surgery
- Control of metastatic foci in the liver: doctors close the lumen of hepatic artery branches with emboli
How is chemoembolization for NETs performed?
A transfemoral approach is used to perform chemoembolization. Doctors make a small incision in the groin area to insert a catheter through the femoral artery into the blood vessels supplying the pancreatic tumor.
The procedure is minimally invasive, well tolerated, and does not require a long hospital stay or rehabilitation. It is performed under local anesthesia with intravenous sedation. Doctors use X-ray guidance. They inject a contrast agent and take images to visualize how blood is supplied to the tumor and where emboli need to be injected. Tiny microspheres saturated with chemotherapy drugs are delivered as close to the tumor as possible. They are usually injected into the pancreatic arteries.
Where can I undergo treatment?
You can seek medical attention from one of the German clinics to undergo your diagnostics and treatment of pancreatic NETs. Germany uses advanced techniques, including chemoembolization. This procedure is combined with systemic cancer control methods, which allows patients to expect the best treatment results.
You are welcome to use the Booking Health service to find out the cost of procedures and surgical interventions. The prices will be lower for you due to the absence of additional fees for foreign patients. You can make your treatment appointment through the Booking Health service. Our company's specialists will help you select the most suitable hospital and arrange your trip to Germany.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. 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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