Cervical cancer treatment in Germany: diagnosis, therapy and surgery

Treatment of cervical cancer in Germany is known for its excellent results; thanks to the skill of German doctors, the survival rate in this country is one of the highest in Europe.

Malignant tumors of the cervix, also called cervical carcinomas, usually develop from the squamous epithelium in the area of the outer cervix.

They usually arise in the so-called transition (transformation) zone.

Malignant degeneration of healthy tissue is a process that has been going on for years, and is mainly associated with the human papillomavirus (HPV).

For example, women are diagnosed with in situ carcinoma at an average age of 34 years, and invasive cervical cancer is diagnosed at an average age of 55 years.

In Germany, about 4,540 women develop cervical cancer every year.

However, since the cervix is easily accessible for examination, cell changes can be detected early and successfully treated. Therefore, the number of deaths in Germany has decreased dramatically over the last 30 years.

The incidence varies significantly with age. Cancer is often diagnosed in women aged 40 to 59 years. The next peak in incidence is observed after 60. The relative five-year survival after diagnosis of an invasive cervical cancer is 69%.

Possible symptoms of cervical cancer

Precursors of malignant changes in cervical cells do not cause discomfort. Even cervical cancer in its early stages is usually asymptomatic. This underlines the importance of regular gynecological examinations for diagnosis.

If the disease is already at a late stage, the following symptoms may occur:

• Bleeding after intercourse
• Bleeding after stress, such as cycling or constipation
• Unusually heavy menstrual bleeding
• Lower abdominal pain
• Unexplained weight loss

But other harmless changes in the cervix can cause such bleeding. If you notice these symptoms, you should ask your doctor to find out the cause.

Note: Constant back pain without organic reasons should also be discussed with the gynecologist.

This may be a symptom of a malignant neoplasm of the cervix.

Best cervical cancer treatment centers in Germany

There are several dozen clinics in Germany that offer diagnostics and treatment of cervical malignant neoplasms. Among them there are large academic hospitals and private medical institutions that have vast clinical experience. Local professionals who can offer the best treatment for cervical cancer in Germany. As a rule, such centers accept international patients and have the appropriate infrastructure.



In general, when choosing a cancer treatment center in Germany, medical tourists should ask about the certificate, the proposed treatment methods and the number of patients with a specific diagnosis who receive treatment at the selected clinic each year.

We can recommend the following medical institutions:

• University Hospital Aachen
• University Hospital Essen
• University Hospital Charite in Berlin
• Krankenhaus Nordwest in Frankfurt am Main
• Asklepios Klinik Barmbek in Hamburg
• Helios Klinikum Berlin-Buch

The experience of medical personnel (especially surgeons and surgical teams) determines the effectiveness and safety of treatment. Do not forget to ask about the cost of hospital stay and specific services, which may differ significantly.

As a rule, cervical cancer diagnosis and treatment in Germany is much cheaper compared to the United States, even with the cost of travel and accommodation.

Cervical cancer diagnosis in Germany

If cervical cancer is suspected, the doctor starts the necessary examinations. Modern diagnostic methods will quickly determine whether it is cancer, what type of tumor is present and how far the disease has spread.

The most important stages of diagnosis are:

• Oncologist consultation: starting $ 500
• Physical examination (gynecological examination)
• Tumor marker blood tests: starting $ 400
• Smear (Pap test)
• HPV Tests

In case of positive results, the following methods are used:

• Colposcopy (mucosal examination)
• Cone-shaped excision of cervical tissue (conization)
• Target cervical biopsy: starting $ 2,000

The cost of cervical cancer screening in Germany is approximately $ 3,000. The cost of a comprehensive diagnosis including tests for tumor markers and diagnostic imaging is approximately $ 4,000-8,000.

Crucial for the diagnosis of cervical cancer is a tissue biopsy, which is performed to determine the type of neoplasm and its biological features. This procedure is necessary in all cases. If cervical cancer is confirmed, additional diagnostic studies will follow. First of all, they must demonstrate how far the tumor has spread throughout the body. Your doctor must find out whether the lymph nodes are affected and whether secondary tumors (metastases) have formed in other parts of the body.

It should be understood that a thorough diagnosis is not just a waste of time and money. Without these diagnostic tests, it is impossible to choose the optimal therapy. German doctors always strive to achieve the highest possible clinical results for a particular patient.

Additional methods include:

• Ultrasound examination (sonography) of the reproductive organs, kidneys and liver
• X-ray examination of the lungs in the late stages of the disease
• Cystoscopy and colonoscopy in the late stages of the disease
• Fractionated diagnostic curettage in case of unclear results
• Mammography and breast ultrasound to rule out concomitant breast cancer
• Surgical staging for the determination of tumor spread in the pelvis and lymph nodes
• Examination of sentinel lymph nodes (special conditions required)
• Laboratory tests (blood test for tumor markers)
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)

Only when all the necessary examinations have been completed, the doctor discusses with the patient which treatment measures are best suited.

Note: performing the above examinations does not mean that you have metastases!

Cervical cancer treatment in Germany: methods and prices

After the diagnosis of cervical cancer has been established and the stage of cancer has been determined, the most appropriate treatment is selected. Before you begin, discuss with your doctor important issues and plans for the future, such as having a baby. Some procedures may ruin your plans.

When developing a treatment plan, specialists from different areas of medicine work in close contact. Doctors are required to act in accordance with German clinical guidelines S3-Leitlinien, which are approved by medical societies. They are regularly updated according to the evidence-based medicine.

Modern cervical cancer treatment methods include:

• Surgical removal
• Cytotoxic chemotherapy
• Targeted therapy
• Radiotherapy

In many cases, these methods are used sequentially or in approved combinations. The choice of therapy depends on the size and spread of the tumor. The age, general health, and even plans to have children in the future are also taken into account by German doctors.

The most important treatment for cervical cancer in the early stages is surgery. Radiation therapy is possible in combination with chemotherapy. Chemoradiotherapy is especially often considered if the operation cannot be performed for health reasons or is undesirable for other reasons.

In advanced stages of the disease, radiotherapy is the method of choice. Currently, the combination of radiation therapy with chemotherapy is the "gold standard" for cervical cancer treatment in Germany. If at the time of diagnosis the tumor can no longer be removed by surgery and / or radiotherapy, doctors prescribe chemotherapy alone. In this case, we are not talking about the so-called curative treatment. The goal is to stop the spread of the tumor and alleviate the symptoms associated with cancer.

It is important to discuss with your doctor the expected results and prognosis before starting treatment. Among other things, specialists should talk about the impact of specific forms of therapy on your physical and mental well-being.

Women of childbearing age who still want to have children should always discuss this problem before starting treatment because of the potentially irreversible effects.

Surgery

The preferred treatment for early stages of cervical cancer is surgery to remove tumor tissue and affected lymph nodes, which should completely cure the disease.

Surgery can be performed for diagnostic purposes to determine the spread of the tumor. Depending on the complexity of the surgical procedure, various undesirable health effects may occur, including reproductive effects.

German surgeons are doing everything possible to minimize the risk of complications, but no one can guarantee 100% success. When choosing a clinic and a surgeon, pay attention to the experience in performing certain operations.



Remember: surgical experience is inversely proportional to the risk of complications!

In the case of very small tumors, a cone-shaped excision (conization) can be recommended. The tissue cone can be removed using the electric loop or laser beam. If it is not sufficient, a partial cervical amputation (trachelectomy) with permanent cerclage can be done.

The approximate cost of conization in Germany is $ 6,000-8,000.

After both surgeries, pregnancy is still possible. However, there is an increased risk of premature birth because the cervix has been weakened. After a trachelectomy, the delivery must be performed using a caesarean section. After completing family planning, the uterus is removed to avoid cancer recurrence.

If the tumor has already penetrated into the deeper layers of the tissue, it is usually necessary to completely remove the uterus (hysterectomy). Often, the upper part of the vagina and the pelvic lymph nodes are also removed.

In postmenopausal women, it is often recommended to additionally remove the ovaries and fallopian tubes. In younger women, surgeons try to keep the ovaries in order not to disrupt the production of hormones.

The cost of hysterectomy in Germany is $ 15,000-25,000, depending on the clinic.

If subsequent radiotherapy is planned, another procedure may be suggested in which the ovaries are removed from the irradiation zone and fixed on the pelvic wall (ovariopexy). This method protects the ovaries from radiation.

The classical surgical method for early invasive cervical cancer is radical hysterectomy (complete removal of the uterus). During surgery, the surgeon checks if the cancer has spread to the adjacent pelvic organs. If the bladder and rectum are affected, it may require partial or complete removal of these organs (pelvic exenteration). It is considered one of the most complex and destructive procedures.

In many clinics in Germany, surgery is often performed laparoscopically (keyhole surgery), that is, without an abdominal incision (laparotomy). In the short term, the risk of complications is much lower, but the time of the procedure increases significantly. The long-term result appears to be the same.

After surgery, radiotherapy may be prescribed, possibly in combination with chemotherapy (adjuvant chemoradiation therapy). German doctors rarely use this regimen (for certain risk factors or significant tumor invasion) to destroy all remaining tumor cells in the body and reduce the risk of disease recurrence.

Radiation therapy

In the later stages of the disease, radiation therapy can be considered. Studies have shown that in these cases, radiotherapy, chemoradiotherapy and surgery provide comparable long-term results. When surgery is impossible or undesirable, radiotherapy can be a valuable alternative.

The cost of radiation therapy for cervical cancer in Germany is $ 8,000-10,000 or more.

Patients with additional risk factors are given radiation therapy after surgery to reduce the risk of local recurrence (usually in combination with chemotherapy, adjuvant chemotherapy and radiotherapy).

The goal of radiation therapy is the destruction of malignant cells. For this, the so-called external and internal radiotherapy (brachytherapy) is used. With brachytherapy, the radiation source is introduced into the uterine cavity or vagina and remains there until the desired dose is reached. The irradiation in this case is localized, so that the neighboring organs are protected.

In addition, all the pelvic organs and even the lumbar lymph nodes can be irradiated from the outside through the skin (external radiotherapy). Thanks to modern computer technologies and effective protection of surrounding organs, the side effects of radiotherapy are usually minimal.



Chemotherapy therapy promotes full recovery. Radiotherapy acts locally, that is, only in the area that was irradiated. Chemo affects all cancer cells scattered throughout the body. In addition, chemotherapeutic drugs disrupt the survival mechanisms of tumor cells, increasing the radiation sensitivity of the tumor.

The concept of radical surgery to remove the lymph nodes does not require additional radiation therapy, even taking into account risk factors. In these cases, German oncologists recommend only chemotherapy, which means reducing the side effects of treatment. This concept is currently being studied in a multicenter observational study.

What are the side effects of radiotherapy?

The discomfort that occurs after radiation therapy depends on many factors, including radiation dose. The more intensive the treatment, the faster the complaints can appear. Due to the damaging effects of radiation on the mucous membranes, inflammation of the bladder and intestines may occur. Typically, inflammation disappears within a few weeks. Chronic inflammation with bleeding rarely develops.

In addition, the vagina becomes susceptible to infections. Irradiation can also cause leg swelling (lymphedema).

Fortunately, these side effects can be controlled with modern drugs and non-drug methods. German medicine uses its entire arsenal to make life easier for patients with cancer (physical therapy, medicines, herbal remedies, etc.) If the ovaries are not removed, subsequent radiation therapy can cause permanent impairment of their function. As a result, menopause symptoms occur.

Chemotherapy

Chemotherapeutic drugs interfere with the different phases of cell division. Therefore, cytostatics work well against rapidly dividing cells (this is a feature of cancer cells). Due to the high radiation sensitivity of cervix cancer, adjuvant chemotherapy is usually prescribed to make the tumor even more sensitive to radiotherapy. Studies have shown that a combination of radiotherapy and chemotherapy with cisplatin leads to significantly better treatment results.

Chemotherapy without additional methods of treatment is mainly used for metastases, as well as to relieve symptoms in the later stages of the disease (palliative treatment). Neoadjuvant chemotherapy for ovarian cancer in Germany can be prescribed before surgery to reduce the size of the neoplasm.

Studies have shown that the best results can be achieved with platinum-based polytherapy (taking several drugs).

Examples include widely used combinations such as cisplatin (a platinum compound) + topotecan (topoisomerase inhibitor) or cisplatin + paclitaxel (taxane). The addition of targeted therapies (antibodies), such as the VEGF inhibitor bevacizumab, provides additional benefits without significantly increasing toxicity.

The approximate cost of chemotherapy in Germany is $ 3,000-6,000, depending on the drugs used.

What are the side effects of chemotherapy?

Short-term side effects of chemotherapy include hemogram changes, hair loss, nausea and vomiting, diarrhea, inflammation of the mucous membranes, immunodeficiency, anemia, and sensory disorders. To alleviate or prevent side effects, German oncologists use various medications and non-drug approaches (for example, taking antiemetics or correcting emotional disorders).

Targeted therapy

Bevacizumab (Avastin) is a monoclonal antibody to vascular endothelial growth factor (VEGF), widely used in the so-called “targeted therapy”. This is a relatively old and well-studied agent. Bevacizumab acts primarily on fast-growing tissue. It prevents the formation of blood vessels (angiogenesis), which are necessary tumors for survival and growth. This reduces the blood supply to the tumor, slows its growth and makes the cancer more sensitive to other treatments.

Studies in Europe and the United States have shown that adding bevacizumab to standard palliative chemotherapy increases the survival of patients with metastatic cervical cancer by several months.

Today, a number of new methods of cervical cancer treatment in Germany are being developed. We hope that they will improve the prognosis for this disease in the next few years.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator