Treatment of esophageal cancer in Germany

“A complex disease with an unfavorable prognosis” – this is how many oncologists characterize esophageal cancer. Treatment in Germany significantly increases the chances of patients with this type of cancer for a full recovery in the early stages. It also gives hope for a long remission with a good quality of life in advanced cases.

The following factors ensure this result of therapy:

• Treatment of esophageal cancer in Germany is performed in specialized departments of large medical centers, such as the University Hospital Essen.
• They are regularly certified by the German Cancer Society (DKG) and are well equipped to treat patients with cancer.
• The doctors who treat esophageal cancer are very highly qualified and experienced. Many of them are members of national and international specialty societies, professors at university clinics and leading specialists in this field of medicine.
• Surgeons, oncologists and radiologists combine standard therapies, which are part of international protocols, with innovative techniques. Some of them are available only when treating esophageal cancer in Germany.
• After the main treatment, patients are rehabilitated. Its goal is to ensure a satisfactory quality of life at any stage of the disease.

Oncology centers in Germany accept complex patients who were denied treatment for esophageal cancer at their place of residence due to the neglect of the case. Therefore, in their reviews of esophageal cancer treatment in Germany, patients from Eastern Europe and Central Asia emphasize that German clinics are their last chance and hope. At the same time, they note that the prices for esophageal cancer treatment in Germany are less than in the USA, about the same as in Israel and more than in Turkey.

Why does a person need an esophagus?

It is an organ of the digestive system – a hollow muscular tube, 23-25 centimeters long, which carries food from the mouth and pharynx to the stomach. The passage of food is provided by contractions (peristalsis) of the esophageal muscles and two sphincters. When the latter does not work well, acid reflux occurs – throwing stomach acid from the stomach. This causes heartburn and, over time, gastroesophageal reflux disease (GERD). This pathology often leads to changes in the mucous membrane cells in the lower third of the organ. This pathology is called Barrett’s esophagus and is considered a precancerous condition. If it is treated in time, esophageal cancer can be prevented. Treatment in Germany with an outpatient endoscopic procedure can be arranged with Experts Medical, for example, at the Charité Clinic.

Interesting facts about esophageal cancer

The following information gives an idea about this oncology:

• this cancer is quite rare and accounts for 1% of all cancer diagnoses;
• men get the disease 3-4 times more often than women;
• there are two types of cancer: adenocarcinoma and squamous cell carcinoma;
• adenocarcinoma develops from mucus-producing cells in the lower part of the organ against the background of GERD and Barrett’s esophagus;
• squamous cell carcinoma develops in the upper and middle part of the organ in people who abuse alcohol and smoking;
• in the early stages of this cancer there are no symptoms;
• In later stages, dysphagia – swallowing disorders, vomiting, nausea, and chest pain – may occur as the esophagus narrows due to tumor growth;
• there is no screening for this type of cancer yet, so it is more often diagnosed when the tumor has already spread outside the organ.

Unique opportunities for patients in German clinics

Germany is constantly conducting clinical trials of new treatments for esophageal cancer. Several studies are investigating the use of chemoradiation therapy in combination with immunotherapy and targeted therapy to improve survival without surgery. Proton therapy is also being investigated in Germany as a non-surgical treatment for esophageal cancer.

These treatments are available to international patients. For pricing on innovative esophageal cancer treatments in Germany, contact an Experts Medical coordinating physician by leaving a request online.

The 5-year survival rate for people with cancer that has not spread beyond the organ is 48%. This rate in patients with a malignant tumor that has spread to surrounding tissues and/or neighboring lymph nodes is 26%. If the cancer has metastasized to other body areas, the 5-year survival rate is about 6%. The overall 10-year survival rate for all stages is 21%.

German experts believe that every cancer case is unique. Esophageal cancer is no exception. Treatment in Germany involves an individual approach to each patient – the development and implementation of a personalized treatment protocol. As a rule, it includes targeted therapy and immunotherapy. This constantly improves the prognosis of the disease, even at advanced stages. Therefore, often the 5-year survival rate of a patient with advanced cancer is greater than the statistical average. Residents of different countries confirm this in their reviews of esophageal cancer treatment in Germany.

Germany uses diagnostic methods that are included in the latest international protocols. The diagnostic plan combines several types of examinations.

Endoscopy with biopsy

Endoscopic examination remains the main diagnostic method. The doctor examines the inside of the esophagus using a latest-generation digital endoscope. If altered areas, formations or “growths” are detected, the doctor performs a biopsy – taking pieces of tissue for examination. During endoscopic ultrasound (EUSI), he determines the degree of tumor sprouting into the wall of the esophagus, adjacent lymph nodes and organs. He can also perform a puncture biopsy of a suspicious lymph node.

In addition, patients undergo an innovative liquid biopsy – blood analysis to detect circulating malignant cells and their fragments.

Visual examinations of the primary tumor and metastases

The plan for further examination of patients usually includes:

• esophageal radiography with barium;
• Multispiral CT and/or MRI with a contrast of the neck, thorax and abdomen;
• ultrasound of the neck and liver;
• PET-CT (positron emission computed tomography) – a hybrid technology that provides molecular visualization of all metastases in the body.

All examinations in German clinics are performed on the latest generation machines, so doctors accurately determine the stage of the disease – the prevalence of cancer in the body.

Studies of malignant cells: oncomarkers and mutations

When treating esophageal cancer in Germany with the help of laboratory studies, doctors-morphologists determine:

• the histological type of cancer (what cells the tumor consists of);
• the degree of malignancy of these cells;
• the depth of invasion (sprouting) of cells (only in the mucosa, submucosa, or deeper);
• presence or absence of oncomarkers – proteins that are produced by malignant cells in a given cancer, e.g. PD-L1, TPS;
• genetic mutations in the tumor cells HER-2 and MSI (in adenocarcinoma).

The last two tests are needed to prescribe targeted and immunotherapy.

An example of how esophageal cancer is treated in Germany is treating this disease at the Center for Visceral Oncology at the Klinikum Helios in Leipzig.

Interdisciplinary oncology consilium for each patient

Each cancer case is discussed by a consilium involving many specialists who diagnose and treat this cancer disease. The team of doctors includes:

• An endoscopist;
• a gastroenterologist;
• a visceral surgeon;
• radiation therapist;
• chemotherapist;
• pathohistologist;
• nutritionist.

The doctor’s “collective mind” evaluates the patient’s general condition, all the tumor’s characteristics. After an exchange of opinions, doctors select the most effective treatment option, corresponding to the stage of the disease and the degree of risk of metastasis. As in other types of cancer, in most cases, multimodality therapy is used, which includes surgery, chemotherapy, radiation treatment, targeting and immunotherapy in different sequences.

Endoscopic treatment in the early stages

If the tumor is small and cancer cells are found in the mucosa and submucosal layer, its removal (surgical excision or radiofrequency ablation) is performed using an endoscope. This type of treatment allows preserving the esophagus, but it is used mainly in precancerous conditions and only at the earliest stages.

Minimally invasive surgery for esophageal cancer

The surgical treatment of this cancer is very complex due to the location of the organ in two body cavities. To remove the tumor with part of the esophagus, the surgeon often operates in both the abdominal and thoracic cavities at the same time. To minimize complications, German doctors perform two-cavity surgeries as minimally invasive interventions. Surgeons resect the tumor using thoracoscopy and laparoscopy through small incisions. If a large fragment of the esophagus is removed, the surgeon may “tighten” the stomach and form a tube from it, or use part of the small intestine to reconstruct the organ.

Postoperative specialized care and feeding of the patient is provided by highly qualified medical staff. In their reviews of esophageal cancer treatment in Germany, patients note that the professionalism and friendliness of nurses helped them to recover quickly after surgery.

Effective chemoradiation treatment instead of surgery

Combined chemoradiation treatment includes the use of the latest generation of chemopreparations and advanced techniques of tumor irradiation. It is prescribed to shrink tumors before surgery, to prevent recurrence and to improve survival after surgery.

This effective treatment is also successfully used in patients who have contraindications to radical surgery and stage IV cancer.

Targeted and immunotherapy for esophageal cancer

Targeted therapy and immunotherapy play an important role in the treatment of this type of cancer. For example, one of the targeting drugs related to monoclonal antibodies is used as a first-line treatment for adenocarcinoma with HER-2 mutation.

A PD-L1 protein inhibitor is being used as a highly effective immunotherapy drug in patients with PD-L1-positive or advanced squamous cell cancer. These and other novel targeted and immunotherapy drugs significantly improve prognosis and survival.

Specialized care for patients with dysphagia

The clinic has a separate multidisciplinary team of specialists to help patients with dysphagia. Patients with narrowing of the esophagus have a stent placed, which immediately improves their condition. If the situation permits, gentle radiation treatment, most often brachytherapy, is performed. Patients are fed through a tube and parenteral (intravenous) nutrition if necessary. This provides an opportunity to improve nutritional status and carry out essential treatment.

The best esophageal cancer treatment in Germany is the one a tumor board chooses for your stage and tumor type. The board includes a surgeon, an oncologist, a radiation oncologist and a gastroenterologist.

• Stage 2 esophageal cancer treatment in Germany usually combines chemotherapy or chemoradiotherapy before surgery with removal of the affected part of the esophagus.
• Stage 3 esophageal cancer treatment in Germany follows the same principle. If surgery is not possible, chemoradiotherapy can be the main treatment.
• For stage 4 esophageal cancer, treatment in Germany focuses on drug therapy and on making swallowing easier. The choice of drugs depends on tumor tests, for example for HER2 and PD-L1.

Proton therapy for esophageal cancer in Germany is used in selected cases. Protons can lower the radiation dose to the heart and lungs. Whether this method suits you is decided by the radiation oncologist after reviewing your scans.

Read reviews of esophageal cancer treatment in Germany on the website and with the help of Experts Medical’s coordinating physicians. Most patients in their reviews note that during esophageal cancer treatment in Germany, they received such medical care, attention and care that they had no doubts about the excellent result. Most often we are talking about clinics Nordwest and Sana Klinikum Lichtenberg in Berlin.

Prices for medical services that a patient receives during treatment of esophageal cancer in Germany correspond to the complexity of therapy of this oncology. The following examples will help to understand the level of prices that a patient wishing to undergo esophageal cancer treatment in Germany will have to deal with:

• endoscopy with biopsy – from €1500;
• PET-CT – from €5000;
• surgery – from € 20000;
• chemotherapy – from €3000;
• radiation therapy from €8000;
• Targeted therapy or immunotherapy – from €6000.

You can check the cost of medical services in different cancer centers with the coordinating doctor of Experts Medical.

To do this, you need to leave a request on the website to the Experts Medical coordinating physicians for free consultation on this issue. The service expert will select a specialized oncology center with everything you need to treat esophageal cancer successfully. Treatment in Germany with the support of Experts Medical will be organized at a high level and in the shortest possible time.