COLORECTUM CANCER STANDARD TREATMENT

Bowel cancer is one of the most common oncological diseases in the world. The diagnosis are common for West and East European countries. Effect men more than women.


Even with standard and improved standard methods of treatment, it has been possible to significantly reduce the mortality rate of people with colon cancer.

Despite that hospitals we are working with has amazing survival rate, still, the late diagnosis of the disease remains a major problem.


Cancer can be detected at an early stage, if the examination is carried out in a timely manner having in mind that in most cases cancer does not develop "out of nowhere".

There are many precancerous diseases that can be detected and be treated on time, preventing malignancy.


The main precancerous diseases of the bowel cancer are:



  • Crohn's disease
  • Chronic inflammation of the large intestine
  • Ulcerative colitis
  • Diverticula of the intestine
  • Polyposis


Book Your Colorectum Cancer Standard Treatment Here

STANDARD PROCEDURES IN EUROPE AND IN THE UNITED KINGDOM

SURGERY

Surgery may be carried out to remove cancer from the bowel.


Part or all of the bowel around the cancer may also need to be removed.


To help your recovery, you may need a colostomy or ileostomy, which may be temporary or permanent

RADIOTHERAPY

Radiotherapy uses radiation to kill cancer cells. A machine is used to target beams of radiation directly at tumours.

You may have radiotherapy for bowel cancer if:

  • you have cancer in your rectum
  • the cancer has spread to other parts of your body

CHEMOTHERAPY

You may have chemotherapy for bowel cancer:

  • after surgery to try to stop the cancer coming back
  • if you're unable to have surgery
  • if cancer has spread to other parts of your body


TARGETED MEDICINES AND IMMUNOTHERAPY

Targeted medicines kill cancer cells.

Immunotherapy is where medicines are used to help your immune system kill cancer.


Targeted medicines or immunotherapy are sometimes used to treat advanced bowel cancer that has spread to other parts of the body.


Targeted medicines and immunotherapy may be used:

  • before surgery to help make the cancer smaller
  • after surgery to lower the chance of the cancer coming back
  • if you have secondary breast cancer to help control your symptoms
  • if you are not able to have surgery



IF YOU BEEN TOLD CANCER CANNOT BE CURED

If you've been diagnosed by your hospital with advanced bowel cancer, it may be hard to treat and not possible to cure you still have to go for second opinion or to try treatment with the most advance and improved medication and treatment for colon cancer available


Colon-Rectum cancer treatment by Zdenko Kos Foundation


The aim of treatment will be either eliminating the cause or to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer.


Finding out cancer cannot be cured can be very hard news to take in.

You'll be referred to a team of doctors and nurses called a symptom control team or palliative care team.

CLASSIFICATION OF COLON CANCER

Classification of malignant intestinal tumour (clinical practice):


  • TNM classification (determines the stage of colon cancer)
  • Histological classification
  • Types of cancer by localization
  • Types of cancer based on the degree of tissue differentiation
  • The nature of growth is also determined. It can be endophytic, exophytic or mixed. Endophytic growth occurs when the tumour grows inside the organ wall. It is characterized by a more unfavourable course, because it sprouts faster into neighbouring organs and gives metastasis earlier. Exophytic growth occurs when the tumour grows toward the intestinal cavity.


According to the histological classification, there are the following types of bowel cancer:


  • Adenocarcinoma (95% of all neoplasms)
  • Carcinoid tumours
  • Stromal tumours
  • Lymphomas
  • The histotype of the tumour influences how long the bowel cancer will last. Adenocarcinoma can be mucous. Then it has a worse prognosis, as the bowel cancer in this case develops quickly and is more difficult to treat. These types of tumours are divided into mucous, mucoid and colloidal. There are also ring-shaped and muco-cellular adenocarcinomas. The histological type is determined by biopsy. It influences the treatment of colon cancer.


Depending on the localization, there are such types of cancer:


  • Cancer of sigmoid colon – half of all cases
  • Cecum – 20% of all cases
  • Appendix
  • Ascending, descending or transverse colon
  • Hepatic or splenic flexure
  • From a clinical point of view the most important classification is TNM. Before we proceed to discuss it, we need to understand how and where the bowel cancer metastasizes.


Where bowel cancer metastasizes?

 

Metastases are secondary tumours. They are formed because the tumour cells spread throughout the body in various ways. Bowel cancer with metastases has a much worse prognosis than bowel cancer which did not metastasize. Metastases develop in the late stages of colon cancer. First, regional metastases are formed. Later appear distant metastases.


Bowel cancer metastases have certain characteristics. There are three types of metastases:


  • Lymphogenous – through the lymphatic vessels
  • Hematogenous – through the blood
  • Implant (contact) – when bowel cancer metastases spread through the abdominal cavity


Where does lymphogenous bowel cancer metastasize?


The lymphogenous metastases are the first to develop. They develop during the third stage of colon cancer. The order of occurrence of metastatic tumours is determined by the anatomy of lymphatic vessels and the location of the lymph nodes to the tumour.


As a rule, the sequence, where the bowel cancer gives metastases, is as follows:


  • Epicolic (supracous) and paracolic (intestinal) lymph nodes.
  • Mesenteric or intermediate nodes.
  • Lymph nodes at the root of the mesentery of the large intestine, as well as para-aortic (located near the abdominal aorta) lymph nodes.
  • In patients with this type of metastasizing hyperthermic intraperitoneal chemotherapy (HIPEC) is carried out. HIPEC allows destroying metastases and separate malignant cells in the abdominal cavity. As a rule, HIPEC consolidates the result of surgery and prevents relapse of the disease.


Later, metastases spreading through the lymph nodes get into the lymphatic system. It is located at the level of 1-2 lumbar vertebrae. Through the lymphatic drainage system, tumour cells spread into the venous system. They also penetrate the supraclavicular lymph nodes.


Where does hematogenous bowel cancer metastasize?

 

Hematogenous metastases are manifested later than lymphogenous ones. They develop after the tumour spreads into the blood vessels. Most often bowel cancer metastasizes in the liver, lungs and bones.


In this case proton therapy for metastatic colon cancer is carried out. This is the type of radiation therapy that allows precisely destroying metastatic foci and sparing healthy tissues around them. Proton therapy for metastatic colon cancer is one of the stage 4 colon cancer treatment options, as detection of distant metastases is indicative of stage 4 of the disease.


Embolization or chemoembolization of the hepatic artery is indicated to patients with liver metastases. During embolization doctors block the blood vessel that feeds malignant foci, so that they shrink or disappear. In chemoembolization, emboli are additionally covered with chemotherapeutic agents that release slowly during few weeks. Thus, chemoembolization is more effective due to combining two mechanisms of action.


Invasive metastasizing

 

Another way metastases spread is by the growing of the tumour into the abdominal cavity. It gradually increases in size. At the advanced stages of colon cancer the tumour spreads from the intestine into the cavity of the peritoneum. Parts of the tumour come off and spread to other organs which makes treatment of colon cancer more complicated.


In patients with invasive metastasizing hyperthermic intraperitoneal chemotherapy (HIPEC) is the most suitable therapeutic option. Proton therapy for metastatic colon cancer is also possible.


STAGES OF COLON CANCER

The stage of colon cancer is determined on the basis of three criteria:


  • The size of the tumour
  • The presence of regional and distant metastases
  • The involvement of lymph nodes in the oncological process
  • Stage 0. Stage 0 is localized cancer or carcinoma in situ. This is the most favourable stage of colon cancer, since there are no metastases yet. The tumour did not even spread beyond the intestinal mucosa.


Stage 1

Cancer has already spread beyond the mucosa, i.e. on the submucosa or into the muscle layer. There are no metastases yet.


Stage 2A

New growth spread to all layers of the intestine. But it did not spread to neighbouring organs. There are no metastases.


Stage 2B

The tumour has already gone beyond the walls of the intestine. But it has still not given metastases and has not spread to neighbouring organs.


Stage 2C

The tumour has grown through all the walls of the intestine, has gone beyond its limits, and already infiltration of neighbouring tissues is observed. However, at the 2nd stage of colon cancer there are no metastases yet.


Stage 3A

Often patients ask at what stage of colon cancer do metastases occur. It is at the third stage of colon cancer when they appear. There are only the metastases in the lymph nodes, and they are not yet present in the organs. At 3A degree the tumor grows in the submucosa of the intestinal wall and spreads to 4-6 of the nearest lymph nodes. It can also spread through the entire intestine and affect 1 to 3 lymph nodes. Possible infiltration into adipose tissue.


Stage 3B

Stage 3 of category B is diagnosed in one of the following three cases:


  • The cancer spreads to all layers of the intestine and to the peritoneum, but does not reach the internal organs, spreads into adipose tissue, affects 4-6 of neighbouring lymph nodes
  • The tumour grows into the muscle membrane or through all the layers of the intestine and spreads to 4-6 adjacent lymph nodes
  • The tumour penetrates into the submucosal layer or into the muscular layer of the intestine, and also spreads to 7 or more adjacent lymph nodes


Stage 3C

It is diagnosed in such cases:


  • The cancer spreads to all the walls of the intestine, extends to the visceral part of the peritoneum (the one which covers the internal organs), but does not spread into the organs themselves, also spreads to the 4-6 nearest lymph nodes
  • The tumour grows through all layers of the intestine, as well as 7 or more lymph nodes
  • The tumour grows through all the walls of the intestine, spreads to adipose tissue and affects minimum 1 lymph node

There are no distant metastases in stage 3 of bowel cancer. They appear only at the last stage of colon cancer.


Stage 4

Is characterized by the appearance of distant metastases. It is also divided into three subtypes. At this stage, hyperthermic intraperitoneal chemotherapy (HIPEC) and proton therapy for metastatic colon cancer are performed.


Stage 4A

Bowel cancer of the 4th degree of subtype A is characterized by the tumour germination of all layers of the intestine. There is at least 1 distant metastasis (liver or lungs, as well as distant lymph nodes). In this case, regional metastases may be absent.


Stage 4B

The tumour completely or partially affects the intestinal wall. Regional metastases may be present or absent. There is a minimum of 1 distant metastasis in the organs or several distant metastases in the lymph nodes.


Stage 4C

Bowel cancer of stage 4 subtype C is characterized by complete germination of the organ wall, by the presence of regional metastases and tumour spreading to far-located areas of the peritoneum. In this case, distant metastases may not be present.


The most common metastases of bowel cancer are found in the liver. They are observed in 50% of patients with colon cancer. They are caused by a late diagnosis of onychopathology, as it is usually detected late, i.e. at the third or fourth stages of colon cancer. In this case, chemoembolization or proton therapy for metastatic colon cancer are indicated.


Stage 4 colon cancer treatment options


Stage 4 colon cancer is the most advanced stage of the disease that requires careful assessment of the benefits and risks of all therapeutic measures. Stage 4 colon cancer treatment options are somewhat limited, as curative surgeries are no longer possible and patients may not be able to tolerate systemic chemotherapy due to the impairment of kidneys or liver function.


Stage 4 colon cancer treatment options include:


  • Palliative surgeries (e.g. removing blocked with a tumour part of the intestine)
  • Chemotherapy
  • Hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal cancer spreading
  • Targeted therapies
  • Immunotherapy
  • Radiation therapy and proton therapy for metastatic colon cancer


Stage 4 colon cancer treatment options for patients with liver metastases include hepatic artery infusion or chemoembolization, and ablation of metastatic foci.


The choice between few stage 4 colon cancer treatment options may be complicated, as each of them has benefits and risks. For instance, palliative surgery can restore physiological food passage but it is hard to tolerate it for the debilitated patients.

Chemoembolization is tolerated better, but requires excellent visualization of blood vessels, which is not possible in all healthcare facilities.



PRICES FOR PROCEDURES for Stage 4

PRICES FOR PROCEDURES for Stage 4

Colon cancer Standard and Improved Therapy Price List:


  • Colon cancer stage 4 with minimally invasive surgery £12,700
  • Colon cancer stage 4 with da Vinci surgery £20,000
  • Colon cancer stage 4 with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) £34,800
  • Colon cancer stage 4 with chemotherapy £4,600
  • Colon cancer treatment with embolization or chemoembolization £24,400
  • Oncological rehabilitation £0.00 if booked and admitted by The Zdenko Kos Foundation.


The above figures represent ¼ of original costs because The Zdenko Kos Foundation contribute and cover the balance of ¾ of the real price.

YOUR QUESTIONS ANSWERED

  • Can I choose the hospital for my treatment?

    Yes, you can select the hospital you would like to be during your treatment, however, keep in mind that that particular hospital must have a department and wards for the kind of profile of your medical issue. When the patients identify where they would like to have their treatment, they must have in mind the remoteness from the airports, main road and main railways in cases of any emergencies. 

    We’ll give our recommendation which is based on a long experience and a profound analysis of all criteria necessary for the quality of medical the patients are looking for.

  • How much does treatment cost?

    When you book your treatment with us you will get fix figure of which you are paying just ¼ of original cost only, the balance of ¾ contributed and paid by Zdenko Kos Foundation.

    Costs for hospitals are also fixed for entire year, therefore, if you are having treatment over one year, the hospital costs might changed. Once you make the payment for the hospital (eg. for one year) you have hospital free of any charges doesn't matter how many times and days per year you spent in the hospital, doesn't matter how many times you are booked and discharged from the hospital.

  • What is the cost of your services

    Depending on the duration of the medical program the cost in every hospital doesn't matter, the country may vary -  but not when you are booking with us. Our prices are fixed doesn't matter what we may find once eg. surgery or treatment start. All the costs of our services are significantly lower, up to 80% (depending on  treatment) that you will have to pay either through your health system in your country or when organizing the program on your own. There are several reasons for it: The hospitals provided by us have special contract agreements to have fixed rates with discounts for the entire year. There are no overstated rates. You and the hospital you will be having treatment are insured specially from unforeseen expenses eg. possible complications.

  • With whom will I conclude the contract?

    You must book with us, and you will complete the contract with us - The Zdenko Kos Foundation. It is a contract on the organization of a medical trip and provision of services. The protocol is very clear: 

    [1] You have to make the booking with us online on this web site (see the page with the booking box) for the treatment you are after where we are strongly suggest to give us as much data and images of your medical condition to date that we can contact you directly with our doctors, consultants and other medical staff for the treatment you would like to have. 

    [2] Once booking is completed, you will receive automated mail for the payment to be made. You have to make the payment in full for the treatment you would like to have in maximum 24 hours after the booking. With making the payment you start ball rolling. 

    [3] Being admitted to the hospital, you will conclude a direct contract with us for the provision of medical services.

    {4} Once payment made you will get direct link to the doctor and counsaltant to discuss your case face-to-face via What's Up or other such service provider available to both parties depend on your locatition.

  • Why should I pay you, but not the hospital?

    Firstly, unlike many intermediary firms and portals, we do not take from hospitals a percentage of the medical service cost because we have contract agreement not just with hospitals but also with doctors, consultants and other medical professional in each hospital we are working with. 

    Secondly, we are covering ¾ of costs for your procedure not to mention that your procedure-treatment will be fully insured up to £250,000 (for one year treatment) and automatically up to £500,000 (for 2-5 years treatment). The Zdenko Kos Foundation cover the hospital insurance seperately during your treatment if there may come to unforseen complication during the treatment.

    Finally, as we are registered as charity, we remain independent in choosing a medical facility and work exclusively for the benefit of the patient. Any type of payment for sending a patient to the hospital is prohibited by law, since it contradicts medical ethics.

  • At what point do the services become paid?

    The services for the organization of treatment become paid from the moment you made your medical treatment booking online and make the payment in full. Once this done, pre-treatment consultation will take the place following the initial examination (hospitalization).

  • Can I contact the hospital directly?

    Yes, of course, you can also contact the hospital on your own. You should choose the hospital and the attending doctor, write an email to the chief doctor with a description of your case in English, ask him/her about the possibility of undergoing treatment in the hospital and the approximate cost of staying there. If you have received the consent of the hospital and you are satisfied with the price for the hospital (please specify that it must be the price for one year doesn’t matter on number of admissions and discharges and transfer an advance payment to us on our account. Once full payment is received, we will negotiate special terms with the hospital you select on your own that they will be aware of what and how many procedures they have to have in mind and secure at any time free bad in ward. If you are coming from a non-EU country write an email to the secretary of the hospital with a request to send an invitation for a visa. Please note that the invitation should come from the chief doctor, but not from the hospital's international department. After that you should on your own get a visa for medical treatment abroad, agree with the secretary of the chief physician on the date of the initial examination (hospitalization), translate medical records of local physicians into German or English (depending on the chosen country for treatment), book a hotel, prepare a transfer from the airport and find for yourself an interpreter for communication with the medical staff.

    All these activities are not needed in case you are booking with us and you are choosing a hospital we would recommend. If you book with us, we will deal with your visa (if you are coming from a non-EU country), we will book you a hotel, and do all that is necessary to get you started with your treatment.

  • Shall I pay for a consultation?

    A consultation before the treatment as well as long-distance consultation (if you are not from EU countries) is provided free except when you are returning to your home address and it is necessary to study CT or MRI images as the specialist gives an official consultation with a written opinion.

    If you are not from EU countries it is imperative to translate epicurises and medical records from domestic doctors into English.

    If you opt for our services for the organization of treatment with us, there is no need to translate the medical records. This will be done by qualified specialists.


  • What happens, if I refuse from the treatment?

    If you refuse from the treatment you will get a refund of the advance payment. 

    The expenses for all what has been done to that moment will be deducted acordingly. 

  • Is it possible to postpone the treatment?

    Yes, it is. In case of an advance postponement (more than 48 hours before the start of the treatment), the treatment cost will not be changed, and will be deleyed till as per your request. If you intend to postpone the treatment, you must do so on written only. There may be some additional cost for consultation or pre-treatment appointment, depend on the lenght from the initial day of treatment till the day you want to be.

  • What security and guarantees do I have?

    When booking the treatment with us all medical treatment are fully insured against possible complications and unforeseen contingencies. The additional treatment costs will be covered by the insurance covered and paid by The Zdenko Kos Foundation.

  • How is my personal data managed?

    The Kos Foundation is a Data Controller therefore rest assured that your personal data and all material you submit over our link along with all medical history with us will be protected according to current regulations and legislation, using advanced security technologies. Medical history will not be disclosed to any 3rd party even to your GP without your special written permission.

  • Check list for inpatient and outpatient

    When you pack your bag for your hospital stay, the following things should not be missing:

    For your record

    - Referral certificate from the general practitioner or specialist

    - Health insurance card

    For your treatment

    - Medicines in original packaging that you take at home

    - Current preliminary findings, such as X-rays, CT/MRI, ECG or EEG, blood tests, etc.

    - Doctor's Letters

    - If available, living will and power of attorney

    - If available: allergy passport, vaccination certificate, X-ray passport, diabetic card, blood group card


    For your stay

    - Your aids (e.g. wheelchair, walker, walking stick, glasses, hearing aid)

    - Comfortable clothing

    - Towels

    - Cosmetics and personal care products

    - To pass the time: books, magazines, MP3 player with headphones

    - Contact details of relatives and friends


    Please be aware:

    When you get your inpatient admission appointment, please clarify whether you have to appear fasting on the day of admission.


    Valuables

    If possible, please do not bring any valuables with you, as you are liable for losses. For indispensable valuables, e.g. Your watch or wallet, you will find a small safe deposit box in the closet of your patient room in the Surgery I Dermatology and in the Psychosomatics department. In internal medicine, there is a dispensing point.


  • How are the visiting hours regulated?

    Visitors are not only welcome to us but are also of huge importance for our patients!

    Doesn’t matter with which hospital we are working with you are booking there are variable visiting hours, as well as special visiting hours which are not for regular patients visits. Once you are admitted the care team will give you all the details about visiting hours. There are also alternative that your partner (husband/wife) stay with you during the treatment. Such accommodation is available nearly in all hospitals we are working with. For such accommodation additional charges applies. 

    There are separate visiting hours for intensive care units while parents of young patients in the children's area have unlimited visiting hours.

    Visitors are asked to be considerate of patients and fellow patients. If necessary, the nursing staff of that hospital where you are staying, will point out the necessary rest periods for patients who have just undergone surgery

  • Where can I reach pastoral care?

    All hospitals we are working with offer pastoral care for at the Protestant and Catholic hospital chaplaincy for patients and relatives. For all other religions you will be informed by the care team at that particular hospital on the day of your admission.

  • What help and counselling services are available?

    Doesn’t matter which hospital we are working with you choose, you will be given supports with various counselling services and support services, such as the Social Counselling Service, Psychosomatic consultation service, Special offers for cancer patients, Clinic chaplaincy, Services of other religious communities, Art therapy, Self-help, Hospice and much more.

  • How can I contact social services?

    The Social Counselling Service can advise you on topics such as rehabilitation, post-discharge care, social law, psychosocial care and many other matters. You will get special overview with information and contact details from consultant and care team in the hospital where you start your treatment.

  • Inpatient stay: How is admission made?

    Registration and admission for an inpatient stay

    If you have made an appointment for an inpatient stay in cooperation with The Zdenko Kos Foundation, you will first be "admitted" to hospital of your choice upon arrival. This means that we record your data and inform you about your hospital stay.

    Please ask exactly where you should travel when making an appointment. The Zdenko Kos Foundation has several locations and consists of many individual clinics.

    An overview of the parking facilities at the clinic locations will be provided once you identify the hospital you would like to be admitted to.

    When you get your inpatient admission appointment, please clarify whether you have to appear fasting on the day of admission.

  • What should be considered when discharging?

    Your attending physician has decided that you will be discharged from the hospital. This means that you will either be discharged directly to your home or still need follow-up treatment, which will be carried out on an outpatient or inpatient basis in another clinic or rehabilitation facility. For both situations, you will get full information before discharged date.

  • What do the General Terms and Conditions of Contract regulate?

    Accepting services of The Zdenko Kos Foundation, you are not accepting just our Terms & Conditions but also for the period of your entire treatment or stay doesn’t matter which hospital we are working with, the hospital GTCs and the house rules of that hospital in their respective valid versions which you can see and read on hospital websites directly.