Liver Cancer Treatment in Germany: A Comprehensive Overview

Liver cancer, a severe and life-threatening condition, requires prompt and effective medical intervention. Germany has gained a reputation as a leading destination for advanced healthcare, and its expertise in liver cancer treatment is no exception. 

Whether you are a patient or a caregiver, this blog will provide valuable insights into the various treatment options, the quality of care, and the supportive environment Germany offers. 

Liver cancer is relatively rare but is one of the most common causes of cancer death due to its poor prognosis.

There are currently around 9,500 new cases in Germany per year, with almost 8,000 deaths. 1 in 190 women and 1 in 80 men in Germany develop a malignant liver tumor in their lifetime. The relative 5-year survival rates of patients with the disease are around 14% for women and 18% for men.

Liver cancer treatment costs USD 45000 to USD 55000 in Germany. 

What Is Liver Cancer?

In primary liver cancer, malignant (cancer) cells form in the tissues of the liver. Primary liver cancer can occur in both children and adults. 

The two types of primary liver cancer are:

• Hepatocellular Carcinoma (HCC) is the most frequent type of liver cancer and the third most common cause of cancer-related deaths globally. It usually develops in individuals with long-term liver disease due to hepatitis virus infection or cirrhosis. Men are at a higher risk of developing HCC than women.
• Bile duct cancer (cholangiocarcinoma) typically affects individuals over 50 but can occur at any age. It is often diagnosed when it's advanced, making successful treatment difficult.

What are the Signs and Symptoms of Liver Cancer?

The signs and symptoms of liver cancer include the following:

• A hard mass located on the right side, just below the rib cage
• A swollen abdomen
• Discomfort on the upper right side of the abdomen
• Pain around the right shoulder blade or in the back
• Unusual tiredness or weakness
• Vomiting and nausea 
• Loss of appetite
• Jaundice
• Easy bruising or bleeding
• Weight loss for no known reason
• Pale, chalky bowel movements and dark urine
• Fever

What are the Risk Factors of Liver Cancer?

Risk factors include the following:

• Hepatitis B virus (HBV) infection
• Hepatitis C virus (HCV) infection
• Cirrhosis
• Heavy alcohol use
• Foods containing Aflatoxin B1 (a poisonous fungus that can grow on food items like corn and nuts when they are stored in hot and humid conditions)
• Nonalcoholic steatohepatitis (NASH) can cause cirrhosis that may lead to liver cancer
• Cigarette smoking
• Other conditions include Untreated hereditary hemochromatosis, Alpha-1 antitrypsin deficiency, Glycogen storage disease, Wilson disease, etc.

Treatment of Liver Cancer

1. Surveillance

Surveillance involves closely monitoring a patient's condition and only administering treatment if test results indicate it is necessary due to the condition worsening. This method is typically used for lesions smaller than 1 centimeter discovered during routine screening; follow-up appointments every three months are common. Active surveillance requires undergoing regular exams and tests.

2. Surgery

To remove cancerous liver tissue, a partial hepatectomy may be performed. This involves removing a wedge of tissue, an entire lobe, a larger portion of the liver, and some healthy surrounding tissue. The remaining liver tissue can take on the functions of the removed tissue and regenerate over time.

3. Liver transplant

A liver transplant involves removing the entire liver and replacing it with a healthy liver that has been donated. However, a transplant can only be performed if a donor's liver is available. In cases where a donor liver cannot be found immediately, alternative treatments will be provided while the patient waits.

4. Ablation therapy

Ablation therapy removes or destroys diseased tissue. Different types of ablation therapy used for liver cancer treatment include:

• Percutaneous ethanol injection
• Radiofrequency ablation
• Microwave therapy
• Cryoablation
• Electroporation therapy

5. Embolization therapy

Embolization therapy is an alternative method for patients unable to undergo surgery or ablation therapy to remove tumors that have not spread beyond the liver. This therapy involves blocking or reducing blood flow to the tumor through the hepatic artery using substances. Depriving the tumor of oxygen and nutrients can stop its growth.

The two main types of embolization therapy are Transarterial embolization (TAE) and Transarterial chemoembolization (TACE).

6. Targeted therapy

Targeted therapy is a treatment method that utilizes drugs or other substances to detect and eliminate specific cancer cells. It is known for causing less damage to normal cells than chemotherapy or radiation therapy.

7. Immunotherapy

Immunotherapy uses the patient's immune system to fight cancer. Substances made by the body or in a laboratory boost, direct, or restore the body's natural defenses against cancer.

8. Radiation therapy

External radiation therapy involves a machine outside the body that emits high-energy X-rays or other forms of radiation toward the cancer-affected area of the body. Its purpose is to destroy cancer cells or prevent them from further growth. 

Different types of external radiation therapy that can minimize damage to nearby healthy tissue include:

• Conformal Radiation Therapy: It involves using a computer to create a 3-D image of the tumor, which is then used to shape the radiation beams to fit the tumor. By using this approach, the tumor receives a higher radiation dose, while the surrounding healthy tissue is spared from damage.

• Stereotactic Body Radiation Therapy: To ensure accuracy and minimize harm to healthy tissue, a specialized apparatus is employed to place the patient in a consistent position for each radiation treatment. Over several days, a radiation device administers an increased radiation dose directly to the tumor. This technique, also called stereotactic external beam and stereotaxic radiation therapy, targets the tumor while minimizing harm to healthy tissue.

• Proton Beam Radiation Therapy: It is a form of external radiation therapy that uses streams of tiny positively charged particles called protons to eliminate cancerous cells. This method helps reduce the amount of radiation damage to healthy tissue surrounding the tumor.

How to Prevent Liver Cancer?

Here are some protective factors that can help prevent liver cancer:

• Getting the hepatitis B vaccine
• Getting treatment for chronic hepatitis B infection
• Reducing exposure to foods containing aflatoxin B1

Which Hospitals in Germany Provide Treatment for Liver Cancer?

The leading hospitals in Germany providing liver cancer treatment are listed below:

• Ludwig Maximilian University Hospital, Munich: The hospital has received several certificates and awards recognizing its exceptional service and quality. These include the ISO 9001:2015 certification, IQM quality management certification, and an award from German health insurers. With the outpatient care facilities, more than 2,000 beds are available for partial and complete inpatient treatment, along with 1,700 doctors and 3,200 nurses from over 90 countries to care for the patients well.
• University Hospital Duesseldorf: The hospital comprises 34 individual clinics and over 30 medical institutes and employs over 5,500 individuals. The hospital has an exclusive spectrum of modern diagnostics and high-tech equipment.
• Charite University Hospital: The Charité University Hospital in Berlin is one of Europe's most reputed and largest hospitals affiliated with Humboldt University and Free University Berlin. Charité treats more patients than any other university hospital in Germany, with 692,920 outpatient cases and 152,693 inpatient cases in a year. 

Conclusion

Liver cancer is a complex and formidable disease, but with the advancements in medical technology and the expertise of healthcare professionals, there is hope for those battling this condition. From innovative surgical techniques to cutting-edge radiation therapies and targeted drug therapies, Germany offers a comprehensive range of options for liver cancer treatment.