Oncology in Germany & Switzerland

What is oncology?

Oncology is the branch of medicine concerned with cancer. The term is derived from the Greek words "onkos" for tumor or volume and "logos" for science. The medical term tumor simply refers to a mass in the body which may also be present in the form of cysts or water deposits. On the other hand, cancer describes the malignant degeneration of cells. During such a process, cells alter their normal characteristics by changes in their DNA. Malignant cells do not follow tissue boundaries anymore and do not respond normally to growth signals from the own body, grow without inhibition, do not undergo development until their final stage is reached and spread to other regions of the body. Anyhow, the terms “tumor” and “cancer” are often used interchangeably in everyday clinical practice.

What does an oncologist do?

The major components of this specialty are prevention, diagnosis, treatment and follow-up care of cancer. Oncology cannot be isolated as a single specialty, because it requires interdisciplinary cooperation.

Pediatric oncology

Pediatric oncology or oncology for children is a special field of pediatrics.

Cancer in children and adolescents is are. However, since childhood cancers are usually of specific types which do not occur in adults, these young patients are not treated by “normal” oncologists but rather pediatricians who have specialized in pediatric oncology.

In Germany, around 2000 children develop cancer yearly. The most common cases are leukemia (blood cancer) and malignant lymphomas, followed by tumors of the central nervous system as well as bones and connective tissue. Furthermore, inborn cancers such as nephroblastoma or retinoblastoma are most often diagnosed during the first years of life.

If left untreated, these diseases are usually fatal. On the other hand, about three thirds of the children can be cured long-term with the appropriate treatment.

Therapy always involves psychooncological care for children as well as psychosocial support while including the family.

Cancer prevention

For cancer prevention, most of all your GP is responsible. Also specialists for gynecology, gastroenterology, dermatology and urology are part of direct cancer prevention and diagnosis. It is comprised of two parts:

Minimizing risk factors

• Briefing patients about risk factors for cancer, e.g. smoking, asbestos or mould exposition etc.

• The Standing Committee on Vaccination (STIKO) of the Robert-Koch-Institue recommends vaccination against Human Papilloma Virus (HPV) for all children from 9-14 years, as it reduces the risk for cervical cancer and other cancers of the head, neck and genital region

• Lifestyle changes and reducing exposure to harmful stimuli can prevent cancer

Cancer screening

• Malignant diseases should be diagnosed and treated early, as this offers a significantly improved prognosis

• Screening examinations are covered by the statutory health insurance providers:

• Women from age 20 yearly genital examination, Pap smear of the cervix

• Women from age 30 yearly breast examination for breast cancer screening

• From age 35 once every 3 years a general health check-up including blood and urine analysis, as well as once every 2 years skin cancer screening of the entire skin

• Men from age 45 yearly genital and prostate examination for cancer screening

• From age 50 colorectal cancer screening either by stool samples or colonoscopy

• Women from age 50-69 mammography for breast cancer screening

Cancer diagnostics

To diagnose cancer, initially imaging techniques are employed.

Modern devices offer visualization of body regions or even the entire body in short time, while making the smallest changes well visible. Imaging techniques include:

• Ultrasound
• CT and MRI
• Scintigraphy, SPECT and PET

To confirm the suspected cell changes, if possible, tissue samples are obtained. These are subsequently examined by a pathologist, who will classify the tissue biopsy according to certain factors:

• Type of tissue
• Tumor size
• Tumor malignancy
• Histological characteristics of the tumor

With this data, a prognosis for the course of the tumor disease can be established. Together with the pathological criteria, this will be decisive or the appropriate choice of treatment.

Oncological diseases can be treated in the hospital or on an outpatient basis. This depends on the general health status, the precise disease and also the patients’ own preference.

Follow-up care is arranged by the outpatient doctor or by the hospital which carried out the treatment. For all patients who have undergone radiotherapy, there is also a duty of follow-up care by law. For example after therapy of breast cancer, all patients are followed up by their treating surgeon, outpatient gynecologist as well as radiooncologist.

Cancer therapy

Specialists for hematology and oncology as well as radiooncology are mostly concerned with diagnosis and treatment of malignant diseases. The most common malignant diseases of women are (in descending order of frequency):

• Breast cancer
• Colorectal cancer
• Lung cancer
• Cervical cancer
• Ovarian or fallopian tube cancer

The most common malignant diseases of men are (in descending order of frequency):

• Prostate cancer
• colorectal cancer
• Lung cancer
• Urinary bladder cancer
• Stomach cancer

The following therapeutic options are available:

• Chemotherapy
• Allogenous or autologous stem cell transplantation
• Antibody therapy
• Dendritic cell therapy

Specialists for radiooncolgy treat cancer with irradiation of the affected areas with photons or ptotons. It is possible to treat cancer with heat (hyperthermia therapy), which is also part of radiotherapy. Radiooncologists are also capable of preventing cancer recurrence by irradiation of previous tumor areas. Nowadays, it is for instance part of the guidelines to treat patients breast cancer patients with surgical excision of the tumor followed by irradiation of the affected breast region. We distinguish:

• Curative: with the intent to cure
• Palliative: to reduce symptoms, e.g. pain associated with bone metastases
• Adjuvant: after surgery to improve the outcome
• Neoadjuvant: before surgery to reduce the tumor size

Specialists for nuclear medicine employ radioactive substances to diagnose and treat cancer. For this purpose, radio-labelled tracer molecules or radiopharmaceuticals are injected into the blood circulation, which in turn attach to the desired structures, for example labelled iodine will only be taken up by the thyroid gland. For tumor treatment, patients receive substances which emit alpha or beta radiation. Since these types of radiation penetrate tissues only a few millimeters, their effect is local just where the substances accumulate.

The radiation damages DNA and other structures of the tumor cells, causing it to die off (necrosis).

Which cancer centers are there?

The German Cancer Association certifies medical facilities on three levels. Since 2005 they certify organ cancer centers on the third level, since 2008 “oncological centers” on the second level and “oncological centers of excellence” on the first level.

The independent institute OnkoZert is responsible for the entire certification system.

To get these certificates, a number of requirements have to be fulfilled. Among others, they include that:

• an interdisciplinary oncology for all tumor diseases is available.
• weekly interdisciplinary meetings, called “tumor boards”, are implemented.
• guidelines for the treatment of cancer patients are developed and carried out by means of clinical studies.
• tumors are classified with the international TNM system.
• fundamental research programs and their clinical application are developed.
• patients receive psychological and palliative support.
• self-help organizations are included.
• the center links with outpatient doctors and hospitals in the region.
• the quality is recorded and published yearly in so-called benchmarking reports.

Since the summer of 2006, foreign cancer centers can be certified as “European Cancer Center” by the German Cancer Association. For the application, similar criteria as mentioned above need to be fulfilled.

Which doctors and clinics specialize in oncology?

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Experts for cancer include specialists for hematology, oncology, as well as radiooncology and nuclear medicine. Specialists for hematology and oncology focus on diagnosis and treatment of cancer and are primarily specialized in cancer of organs and the blood system. For diagnosis, various imaging modalities are used, which are evaluated in cooperation with radiologists and nuclear medicine specialists.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of oncology and are looking forward to your inquiry or wish for treatment.

Where can I find an experienced oncologist?

Here at PRIMO MEDICO you will exclusively find experienced specialists and clinics for oncology in Germany, Austria and Switzerland. At the moment, you can find renowned specialists in the following cities:

Specialists for oncology in Germany:

• Immuno-oncology Cologne

Cancer specialists in Switzerland

• Oncology St. Gallen

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• zentren.html, aufgerufen am 25.09.2017 
• Krebs in Deutschland 2009/2010. 9. Ausgabe. Robert Koch-Institut und die  
• Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg.). Berlin  
• 2013 
• Von Koh: Darmspiegelung schon ab 50 – vor allem für Männer,  
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• Darmspiegelung-schon-ab-50-vor-allem-fuer-Maenner.php, aufgerufen am  
• 25.09.2017 
• Herold, Gerold (2017). Innere Medizin. Thieme, Köln.