Rectal cancer treatment in Germany

Many patients look for treatment in Germany for rectal cancer because of the way care is organized. Treatment of rectal cancer in Germany does not start with surgery but with a tumor board. The surgeon, oncologist, radiation oncologist, radiologist and pathologist review the scans and histology together. They agree on a plan that covers every step: radiotherapy, drugs and surgery.

Rectal cancer treatment centers in Germany can be certified by the German Cancer Society (DKG). Certification confirms that a center has the required specialists, equipment and surgical experience. The cancer center of Helios Krefeld and the Solingen hospital hold DKG certificates.

The method is chosen by the treating doctor. We help you send your records to the clinic and receive a preliminary plan before the trip.

The rectum is the last part of the large bowel, about 15 cm long. A tumor most often develops from a polyp on its inner wall. In the early stages the disease may cause no complaints, so it is often found during a colonoscopy.

Possible signs are blood in the stool, a change in bowel habits, a false urge to pass stool and a feeling of incomplete emptying. These symptoms also occur in other conditions. Only an examination can find the cause.

For treatment planning, it matters how low the tumor is located. This determines whether the anal sphincter, the muscle that holds stool, can be preserved.

The stage is defined by how deep the tumor has grown, lymph node involvement and the presence of metastases. This requires a pelvic MRI and CT of the chest and abdomen.

• An early tumor can sometimes be removed locally, without removing part of the bowel.
• A locally advanced tumor usually needs radiotherapy or chemoradiotherapy before surgery.
• Total neoadjuvant therapy means giving the whole course of chemotherapy and radiotherapy before surgery. It is considered when the risk of recurrence is high.
• Metastatic cancer is treated with drugs, and single deposits in the liver or lungs are sometimes removed.

There is no single best rectal cancer treatment in Germany for everyone. If the tumor disappears completely after radiotherapy, a watch-and-wait approach without surgery is discussed in some cases. It requires frequent follow-up examinations.

The main operation is total mesorectal excision. The surgeon removes the part of the bowel with the tumor together with the surrounding fatty tissue and lymph nodes. The ends of the bowel are then joined if the tumor location allows it.

The operation is done as open, laparoscopic or robotic surgery. At the Solingen hospital cancerous tumors are removed, among other ways, with the Da Vinci robot. The surgeon chooses the approach based on the MRI and your condition.

Sometimes a temporary stoma is created to protect the join in the bowel and is closed a few months later. A permanent stoma is needed when the tumor is too close to the anus.

Treatment for stage 4 rectal cancer in Germany is usually based on medication. This means chemotherapy and, depending on molecular test results, targeted therapy or immunotherapy. Doctors who treat stage IV rectal cancer in Germany also look at whether the metastases can be removed.

If there are only a few metastases limited to the liver or lungs, they are sometimes removed surgically or destroyed with other local methods. The tumor board makes this decision after reviewing all scans. Stage 4 rectal cancer treatment in Germany often continues for months, with breaks between courses. When rectal cancer stage 4 in Germany is confirmed, the plan is reviewed again after each treatment phase.

The HIPEC procedure for rectal cancer in Germany is offered in selected cases when the tumor has spread across the peritoneum. The surgeon removes the visible deposits and then washes the abdominal cavity with a heated chemotherapy solution. The method suits only some patients.

After surgery you stay in hospital for a while, the length depends on the extent of the operation. If a stoma has been created, you are taught how to care for it.

After treatment is completed, a follow-up plan is set: colonoscopy, CEA tumor marker tests and CT at fixed intervals. Your coordinator will discuss with the clinic where to have follow-up examinations, at home or in Germany.

Send your coordinator the colonoscopy report, histology, pelvic MRI and CT. Patients often compare Germany rectal cancer programs with options in other countries, and the coordinator can send your records to several clinics. You will receive a preliminary plan and cost estimate.

Treatment is paid directly to the clinic. The coordinator's services are free for the patient: choosing a clinic, contact with the doctor, help with translating documents and organizing the trip.