Germany: A Leading Destination for Neuroendocrine Tumor Treatment

Germany's healthcare system strongly emphasizes patient well-being, ensuring that individuals receive compassionate care throughout their treatment journey.

Thanks to its advanced medical infrastructure, cutting-edge technology, and highly skilled healthcare professionals, Germany has gained a reputation as a leading destination for treating  Neuroendocrine Tumors (NETs). The country is home to numerous renowned hospitals and specialized clinics that offer comprehensive care for patients diagnosed with NETs.

From surgical interventions and systemic therapies to interventional radiology and nuclear medicine, Germany offers a wide range of treatment options for NETs.

The treatment of NETs typically involves a multidisciplinary approach, including surgery, chemotherapy, radiation therapy, targeted therapy, and supportive care.

The surgery cost for NETs in Germany is USD 5400 to 27100, depending on the location and complexity of the tumor. Radiation therapy can cost USD 5400 and 21700, while chemotherapy may cost USD 2170 and 10900 per cycle. Targeted therapy can cost USD 5400 and 16300 per month.

What are Neuroendocrine Tumors?

NETs are malignant growths that arise from neuroendocrine cells. These cells release hormones into the blood in response to a signal from the nervous system. Neuroendocrine cells can result in flushing and diarrhea and other proteins (e.g., chromogranin A), which serve as biomarkers for NETs. NETs can be benign (not cancer) or malignant (cancer).

The overall incidence of gastroenteropancreatic (GEP) neuroendocrine neoplasms in Germany increased significantly between 1976 and 2006 from 0.31 (per 100.000 inhabitants per year) to 2.27 for men and from 0.57 to 2.38 for women. 

Most commonly occurring in the gastrointestinal tract (48%), lung (25%), and pancreas (9%), NET can also develop in other organs, including the breast, prostate, thymus, and skin.

Some examples of NETs are:

• Carcinoid tumors - Very rare NETs occur most often in the gastrointestinal (GI) system. Carcinoid tumors also can be found in the lungs

• Pancreatic NETs - Neuroendocrine cells in the pancreas affect the production of hormones such as insulin, which controls blood sugar. Pancreatic NETs also are called islet cell tumors.

• Medullary thyroid cancer is a rapidly growing rare cancer that occurs in neuroendocrine cells in the thyroid gland. 

• Pheochromocytomas - A pheochromocytoma is a rare NET in the center of the adrenal glands. 

• Neuroendocrine carcinoma of the skin (Merkel cell cancer) - This aggressive NET arises in Merkel cells, located in the top layer of the skin near nerve endings that receive touch sensations. Merkel cell carcinoma also is called neuroendocrine cancer of the skin. It occurs most often in areas of skin exposed to the sun.

• NET, Non-small Cell Lung - This rapidly growing cancer occurs in neuroendocrine cells in the lungs.

• NET, Small Cell Lung - Several neuroendocrine cancers are classified as small-cell lung cancers but arise in neuroendocrine cells. They are:

  • Low-grade typical carcinoid

  • Intermediate-grade atypical carcinoid

  • High-grade NETs, including large-cell neuroendocrine carcinoma and small-cell lung cancer

Classification of Neuroendocrine Tumors

NETs may be classified in different ways, including: 

• Their location

• Observation of cells under a microscope

• Growth and division of cells 

In addition, NETs are described as functional or non-functional.

Functional NETs -

• Make and release hormones and other substances that cause symptoms. 

• In Carcinoid syndrome, a sign of a functional NET, a substance called serotonin, is released that can cause diarrhea and facial flushing.

Non-functional NETs -

• Either do not release or do not release enough substances to cause symptoms. 

• About 60% of NETs are non-functional. 

• Usually diagnosed at a more advanced stage due to lack of symptoms.

Grades of Neuroendocrine Tumors

WHO divides NETs into three grades:

• Grade 1 (low-grade tumor) cells divide at a low rate and therefore grow slowly

• Grade 2 (intermediate-grade tumor) cells divide at an intermediate rate

• Grade 3 (high-grade tumor) cells divide at a fast rate and therefore grow quickly

Symptoms of Neuroendocrine Tumors

Initially, NETs may not produce any noticeable symptoms. The symptoms depend on the location of the tumor and whether it overproduces hormones.

The signs and symptoms of NET might include:

• A growing lump under the skin

• Losing weight without trying

• Pain from a growing tumor

• Feeling unusually tired

NETs that produce excess hormones (functional tumors) might cause:

• Skin flushing

• Diarrhea

• Frequent urination

• Increased thirst

• Dizziness

• Shakiness

• Skin rash

Risk Factors of Neuroendocrine Tumors

There is a higher incidence of NET in people who inherit genetic syndromes, making them more susceptible to cancer. Examples include:

• Multiple endocrine neoplasias, type 1 (MEN 1)

• Multiple endocrine neoplasias, type 2 (MEN 2)

• Von Hippel-Lindau disease

• Tuberous sclerosis

• Neurofibromatosis

How are Neuroendocrine Tumors Treated?

Individualized treatment plans are formulated based on tumor factors such as site, stage, grade, differentiation, symptoms, and patient characteristics such as age and comorbidities.

Localized disease

• Surgery: The best curative treatment modality is an appropriate surgery focused on margin-negative resection and adequate lymphadenectomy. During the resection, the surgeon needs to examine for synchronous lesions.

• Adjuvant therapy (chemotherapy after surgery): Consensus guidelines recommend adjuvant platinum-based chemotherapy for patients with fully resected, poorly differentiated cancers.

Metastatic disease

• Somatostatin analogues: NETs treatment relies heavily on somatostatin analogues, with two long-acting preparations available: octreotide long-acting repeatable and lanreotide.

• Surgery: Even in cases of metastatic disease, surgery plays a crucial role. If the primary tumor is located in the small bowel, resection is often performed to prevent future obstructions, especially for low-grade tumors with a positive outlook.

• Molecularly targeted biologic therapy:

  • Everolimus, an oral mammalian rapamycin inhibitor target, inhibits cell proliferation, angiogenesis, and metabolism

  • Sunitinib, a multitargeted tyrosine kinase inhibitor, acts by inhibiting angiogenesis

• Peptide receptor radionuclide therapy: This involves attaching a therapeutic radiolabel to a somatostatin analogue that concentrates in neuroendocrine tissue. The radiolabel, most commonly 177 Lutetium (177Lu), can then deliver local cytotoxic radiation to the NET. 

• Chemotherapy: There is usually a dramatic and rapid response to chemotherapy, but subsequent relapse is expected.

Why Choose Germany for Neuroendocrine Tumor Treatment?

Germany's healthcare system is highly advanced and renowned for being a top destination for medical tourism. Various factors make Germany a preferred choice for individuals seeking treatment for NETs:

• Expertise and Specialization: Germany has world-class medical professionals, including oncologists and surgeons, with extensive experience and knowledge in treating NETs. German hospitals and clinics often specialize in diagnosing and treating rare and complex conditions like NETs, ensuring patients receive the highest quality care.

• Cutting-edge Technology and Research: Germany is at the forefront of medical research and innovation. The country invests heavily in state-of-the-art medical technology, ensuring access to the latest diagnostic tools and treatment modalities.

• Comprehensive Healthcare Infrastructure: Germany has a well-developed healthcare infrastructure with modern hospitals, specialized cancer centers, and advanced facilities. These institutions provide comprehensive care, including multidisciplinary teams collaborating to tailor treatment plans for NET patients.

• High Treatment Success Rates: Germany's healthcare system has high success rates in treating various types of cancer. The combination of skilled medical professionals, advanced technology, and a patient-centered approach contributes to favorable outcomes for NET patients.

While the cost of treatment in Germany can be relatively high, the quality of care, expertise, and access to cutting-edge therapies make it an attractive choice for patients seeking the best possible outcomes for their NET treatment.

Top Doctors in Germany Providing Neuroendocrine Tumor Treatment

• Prof. Dr. Med. Michael Bartels: He is a Surgical Oncologist with over 34 years of experience. His expertise includes minimally invasive procedures, hepatobiliary surgery, pancreatic surgery, and colorectal and cancer surgery.

• Dr. Med. Marek Budner: He is a Surgical Oncologist with over 31 years of experience. His expertise includes diagnosing and treating breast diseases, surgical treatment of mammary carcinomas, plastic and reconstructive breast surgery, oncoplastic breast surgeries, and colposcopic diagnostics in the lower genital tract.

• Pd Dr. Med. Ulrich Halm: He is a Gastro-oncologist with over 26 years of experience. His clinical interest lies in gastroenterology, hepatology, and gastroenterology oncology.

• Prof. Dr. Med. Karl-Jurgen Oldhafer: He is a Surgical Oncologist with over 33 years of experience. His clinical interest includes treating biliary diseases, gallbladder tumors, liver diseases, and cirrhosis.

• Dr. Boris Pfaffenbach: He is a reputed Oncologist with an experience of over 28 years. His clinical interest includes treating the gastrointestinal tract, pancreas, and gallbladder disorders. He also performs Esophagectomy and offers chemotherapy, leukemia chemotherapy, and chemotherapy for breast cancer. 

Conclusion

It is advisable to consult with a healthcare provider or medical facility to obtain accurate and up-to-date information on the cost of NET treatment. Patients must discuss their treatment options and associated costs with their healthcare and insurance providers to ensure they are fully informed and prepared for the financial burden of NET treatment in Germany. Additionally, patients may want to explore options for financial assistance or support from advocacy groups or other organizations.