Diagnosis and Treatment

Cancer is on the rise as life expectancy increases and the development of technologies enable earlier and more reliable cancer diagnoses. Cancer diagnosis is done with the most modern technologies available: high-resolution CT scans, magnetic resonance imaging (MRI), PET-CT, and others. These are complemented by pathology laboratory tests and investigations including Immunohistochemistry and innovative molecular diagnosis modalities that help us characterize the type of tumor and its biological behavior and to choose the optimal treatment according to the best potential response to various medications.

Diagnosis and treatment of cancer are no longer the domain of a single doctor, but of a team – The Tumor Board – that determines the optimal way to diagnose and treat your specific tumor. This team is managed by me, the Oncologist, who maintains a broad perspective of the disease and up-to-date knowledge of the array of possible treatments to achieve the best results.

Recent Medical Oncology is tailored to the specific characteristics of the tumor: the type of cancer, its spread, and its biological and genetic nature. It is possible that two people with the same tumor at the same stage of development will receive different treatments based on different features and genetic background of the tumor. Each aspect calls for a different treatment.

In recent years various chemotherapy and chemo biology drugs offer the physician and the patient a broad range of treatment possibilities. Some of these drugs and protocols are covered by the Ministry of Health, some are not but are registered based on international research trials and can be accessed by the Oncologist, and some are in the experimental stage and can also be acquired by participating in these studies under strict conditions set down by the World Health Organization.

To summarize

Cancer has become more endemic it is more widely diagnosed
Some 7-8% of the population have cancer
New technologies enable carefully controlled early detection and treatment
There is a broad range of treatments for various cancer types
The most advanced treatments in many cases are selected according to the specific characteristics of the tumor, necessitating thorough investigation of the tumor before decisions are made about treatment
The choice of a good Oncologist, who works together with the best specialists using the most modern techniques and relates to patients with empathy and understanding can help you fight and overcome your cancer.

The various types of cancer and their treatment

סרטן השד

Breast cancer

Breast cancer is originated in the breast tissue. Its initial signs are lumps, changes in form, Skin dimpling, Nipple discharge. Other symptoms may include swollen lymph nodes under the arm or near the collar bone, pain in bones around the back, ribs and pelvis, short breath and Jaundice. Tumors appear in 99% of women and 1% of men. Between 5%-10% of the tumors are genetically inherited. The main genes that are involved in genetically inherited breast cancer are BRCA1 and BRCA2. Most tumors originate in cells in the ducts (the milk ducts) and are called DUCTAL CARCINOMA or the lobules (glands in the breast that make milk) which are called LOBULAR CARCINOMA.

The type of treatment depends on the stage of discovery, biological factors of tumors and how aggressive they are (Grading, Ki67), hormone dependency (estrogen and progesterone receptors- their strength and the percentage of cells they reside in), HER2 protein, the patients age and health and the existence or lack thereof a genetic factor.

There are several types of treatment with high success rates. Treatment includes surgery, in or post-surgery radiation treatment depending on the size of the tumor and the age of the patient and hormonal, biological, immunological and chemotherapy drugs.

The necessity for chemotherapy depends on the tumor and it is determined by a molecular test. This test has been able to reduce the need for chemotherapy by 30%.

Tailor made treatment based on a molecular or genetic profile is available for breast cancer in certain cases.

מלנומה

Melanoma

Melanoma develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color. Melanoma can also form in your eyes and, rarely, inside your body, such as in your nose or throat. The major risk factor is exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds particularly in light skin and hair individuals. A large number of moles may increase the risk of melanoma when exposed to sunlight or other ionizing radiation.

When should I consult a doctor?

In case of an appearance of a new mole especially if it changes or grows.

If an existing mole change- notice its size, color, irregular mole borders or if it is bleeding or scratching. as melanoma may involve different parts of the body, awareness is key.

In the past years, we have witnessed an evolution in melanoma recovery rates even in early stages. Melanoma has shown the strongest reaction to immunotherapy- a therapy that stimulates the immune system effectively to fight the tumor. Immunotherapy along with new biological treatment give patients hope even if they are diagnosed only in latter stages of the development of the tumor.

גניקולוגיה

tumors in the female reproductive system

Gynecological tumors in the female reproductive system consist mainly of ovarian cancer, uterine cancer and cervical cancer.

Gynecological tumors

Gynecological tumors in the female reproductive system consist mainly of ovarian cancer, uterine cancer and cervical cancer.

Endometrial cancer is the most common cancer of the female reproductive system. Most changes appear due to the hormonal changes that come with menopause and the end of the menstrual cycle. The tumor is more common among overweight and fair skinned women.

Treatment relies on the stage of discovery and on the biological data of the tumor to determine its aggressiveness. In many cases treatment involves surgery, radiation and chemotherapy drugs with or without biological medication.

Ovarian cancer

Ovarian cancer is a "sneaky" type, usually discovered at advanced stages of the tumor when it is already organ spread.

Between 5%-10% of the tumors are transferred and related to genetics. Even if the genetic connection is not clear (BRCA carriers) in some families the probability of the disease is higher. The age of the first pregnancy of a woman is significant in the appearance of this type of cancer. The older the woman is, the higher the risk.

Surgery and drugs are used to treat this type of cancer. In the recent years, much progress has been done in treatment of the tumor even in its advanced stages. This progress has mainly affected BRCA gene carriers but also among other women who receive biological and immunotherapy and biological treatment in addition to common drugs, depending on the profile of their tumor.

Cervical cancer

Cervical cancer is quite rare in Israel but it is considered one of the most common tumors worldwide. Considered one of the most lethal tumors in the past, it has become less prevalent thanks to early discovery through PAP smear tests.

There is a clear connection between the appearance of cervical cancer and HPV (Human Papilloma Virus). An infection within the virus does not cause cancer but can create a foundation for the development of cervical cancer. The virus is contracted through sexual intercourse and it is common among young women who practice unprotected sex. The solution to this problem lies in vaccinating males and females between the ages of 9-45

Prophylactic treatment and early discovery are the keys to recovering from such a tumor. Early discovery allows for a surgery that does not alter the course of life and leaves a chance for healthy pregnancies. Late-stage discovery of the tumor requires vast surgery and intricate radiation, chemotherapy and immunotherapy.

גידולי מערכת העיכול

Gastrointestinal Tumors

The group of cancerous diseases which include Esophageal Cancer, gastrointestinal cancer, small intestine cancer, pancreatic cancer, gallbladder cancer and tumors that originate in the liver, large intestine, rectum and the anus.

Esophageal cancer

The esophagus is a pipe shaped organ, 30 cm long, that stretches from the throat to the stomach. Esophagus tumors are not common in Israel and are related to smoking, excessive alcohol consumption and inflammatory changes that are cause by chronic reflux.

Common symptoms are trouble swallowing solids and later liquids, heartburn, cough, hoarseness, back ache and weight loss.

Diagnosis is done by gastroscopy and biopsy, endoscopic ultrasound (EUS) and PET-CT scans. treatment of the disease depends on the stage of the tumor. In light of the tumor's biology and the sensitivity of the tissue growth it is possible to receive surgical, radiation and chemotherapy.15% of patients who are diagnosed with esophageal cancer located I the latter half of the esophagus and in the esophageal – stomach passage display HER2 protein which allows biological treatment in addition to the others.

gastrointestinal cancer

the most widespread tumor among men over the age of 50. The cause is not clear but there is a clear connection to high alcohol consumption, spicey and canned foods and processed red meat. Another risk factor, if not treated, is the bacterium called Helicobacter Pylori.

Main symptoms of the tumor are ongoing heartburn, upper abdomen pains, digestion difficulty and lack of appetite.

Diagnosis is established through biopsy, EUS-PET-CT and a blood test including Oncomarkers.

Treatment depends on the stage of the tumor upon diagnosis and the result of the tissue growth biopsy. If the tumor is metastatic the tumors size will be reduced by chemotherapy / biological drugs or immunotherapy.

Pancreatic cancer

Most pancreatic tumors (95%) are originated in cells that line the pancreatic tubes and are called pancreatic adenocarcinoma. 80% are located at the upper part of the pancreas. The cause of most pancreatic cancer is unknown but there are a few risk enhancers such as: family history of the disease, genetic mutations in BRCA1+2 genes, smoking, overweight and chronic pancreas infections.

Symptoms of the disease are weight and appetite loss, upper abdomen and back aches, skin and conjunctiva jaundice, recent diabetes and greasy and strong-smelling diarrhea.

Diagnosis is done with pancreas protocol CT, PET-CT AND EUS and includes taking a biopsy in order to maintain a definitive diagnosis. Blood tests with oncomarkers CEA and CA19.9 may support the diagnosis if their values are high and they are useful in tracking the reaction to the different treatments.

The treatment of pancreatic cancer, similar to other tumors, is determined depending on the stage of detection, the general condition of the patient and the characteristics of the tumor. Information about genetics is significant for the choice of treatment of the patient. It has been recently discovered a genetic cause and the choice of treatment have a prognostic significance.

Removing the tumor from the pancreas by surgery is the treatment of choice for patients in the initial stages of the disease. In cases when surgery can be done but the location or size of the tumor requires its reduction, the common approach is to give the patient neo-adjuvant treatment and then operate. In more advances stages the treatment of choice is mainly chemotherapy drugs but if genetics are involved the treatments is according to the diagnosed mutation.

Small intestine cancer and anal cancer

The third most common cancer in men ( after lung and prostate cancer) and second most common in women ( after breast cancer). Around 85% of the cases of small intestine and anal cancer appear randomly without an evident reason.

Risk factors are smoking, alcohol consumption, diet rich with animal fat and unsaturated fat and chronic intestinal infections. Genetics also play a role and their relation is genetically tested for HNPCC ,FAB and LYNCH syndrome.

the high incidence of the tumors is crucial for early detection by fecal occult blood test. If the test is positive, it requires a colonoscopy. HMO insured patients are entitled to a colonoscopy for the purpose of ruling out the existence of tumors and attaining samples. These tests allow an early discovery and removal of the tumor without complementary treatment.

fresh blood or mucus in feces or dark feces in either men or women could be signs of a tumor in the large intestine and the anus. Other symptoms could be irregularities in defecation, stomach pains and bloating.

Diagnosis is achieved with a colonoscopy and a biopsy complemented by CT-PET scans or just a CT as to determine the advancement of the tumor.

The therapeutic approach is determined according to the distribution of the tumor in the organ and throughout the body. surgery is possible even in the case of metastasis in the lungs and liver. Determining whether surgery is required depends on clinical considerations related to the tumor and the patients' general condition.

In many cases of anal tumors surgery will be accompanied by complementary radiation and chemo therapy. In the case colon tumors, the complimentary treatment would be drugs without radiation.

Immunotherapy has been recently found to be effective in treating colon and anal cancer among patients with unique tissue characteristics known as MSI-H.

There are several options of treatment even if the disease in in a state of metastasis in the liver (like SIRT).

liver cancer

Cancer that originates in the liver

Most liver cancer is metastatic tumors but cancer that is originated in the liver is quite common worldwide. It is quite rare in Israel.

Causes of liver originated cancer are viral infections: hepatitis C and B, high alcohol consumption and fatty liver diseases.

At risk population is advise to get a liver ultrasound every 6 months as well as an Alpha-Fetoprotein (AFP) Test. High levels of the protein in the blood indicate the existence of a tumor and a further biopsy will not be needed. In some cases when the protein levels in the blood are not restricted, a triple phase liver CT scan is in order and a biopsy will be taken from the liver.

A confined hepatectomy will be done in early stages of the disease. Some cases require a complete hepatectomy and liver transplant. Chemotherapy (TACE) or radiation (SIRT) can be considered as a preliminary treatment or palliative treatment to increase life expectancy. Drugs a given at advanced stages of the disease. Recently, immunotherapy has shown improvement in even in advanced stages of the disease.

Liver metastases

The liver is one of the most common organs to develop metastases that originate in other organs. Diagnosis is done by using ultrasound imaging and some cases require a biopsy to determine the origin of the cancerous tissue that is found in the liver.

The treatment of liver metastasis is determined by the organ from which the metastasis had developed. The therapeutic approach depends on the amount of metastasis, their position in the liver and the tissue and biological characteristics of the tumor.