Lung cancer treatment in Israel: diagnosis, therapy and surgery
- 25 October
- Diagnosis & Treatment
Lung cancer diagnosis and treatment in Israel offers cutting-edge technology and first-class service with a significantly lower cost of procedures, lab tests, medications, and accommodation compared to the United States or Canada.
Lung cancer is considered a result of mutations, that allow cells to divide uncontrollably and live longer than they should be, occupying healthy tissues.
Cancer is not contagious.
It is impossible to predict.
There is no reliable protection against it. But cancer can be cured.
In Israel, more than 2,000 cases of lung cancer are diagnosed each year, and about 1,600 patients die from this tumor. Despite the impressive achievements of local medicine and the experience of thoracic surgeons, this disease is a tough opponent.
The shockingly bad statistics of lung cancer is explained by the fact that in most cases it is diagnosed at a later stage, when the tumor has already formed metastases throughout the body.
In the early stages, there are no specific symptoms that indicate the development of a malignant tumor inside the chest. Most patients smoke and suffer from chronic obstructive pulmonary diseases, and therefore they do not pay attention to a chronic cough or dyspnea.
There are several types of disease. Non-small cell lung cancer (NSCLC), which is diagnosed in 85% of patients, small cell cancer (SCLC) and rare cancer types like mesothelioma. SCLC is considered the most deadly type; the endless division of its cells is caused by numerous mutations. It quickly metastasizes and is rarely cured by surgery.
Over the past 20 years, the results of small cell lung cancer treatment in Israel have improved significantly, but due to late diagnosis, only a few percent of patients survive more than 5 years.
There are several factors that can increase the risk of lung cancer. The presence of a certain risk factor does not necessarily mean that tumor is inevitable. On the other hand, the absence of these risk factors does not guarantee your safety.
The main lung cancer risk factors are:
• age over 40
• active or passive tobacco smoking
• exposure to asbestos, chrome, nickel
• genetic predisposition
• smoking marijuana
• inhalation of radon
Lung cancer is caused by abnormal cells, which can develop only in the host’s body. Therefore, it is important to note that disease is not contagious. Cancer cannot be transmitted from person to person in any way. Contact with patients is safe if they do not undergo a certain toxic therapy. Even at an advanced stage, the disease can manifest itself only by coughing and shortness of breath, which smokers attribute to chronic bronchitis. Many of the symptoms listed below may indicate late stages of lung cancer, but they may not be associated with cancer at all.
Possible symptoms of lung cancer include:
• persistent cough
• change in habitual cough
• shortness of breath
• wheezing in the chest
• hemoptysis (coughing up blood)
• unusual voice change
• chest or shoulder pain
• poor appetite
• extreme weakness and fatigue
• unexplained weight loss
• difficulty swallowing
• peripheral cyanosis of the fingers and lips
• lymphatic nodes enlargement in neck
If you are experiencing any of these symptoms (especially for 3 weeks or longer), contact your doctor as soon as possible. Remember: late diagnosis always means poor prognosis.
Lung cancer diagnosis in IsraelThe approximate cost of diagnosing lung tumors in Israel is $ 3,800–8,000, depending on complexity of the case. This includes the consultation with specialists, lab tests and imaging.
How is cancer detected?If the symptoms indicate cancer, the patient is sent to laboratory tests, computed tomography and, if necessary, some invasive procedures like fine needle aspiration (FNA). Local doctors always check for cancer smokers aged 40 years and older with hemoptysis.
Computed tomography of the lungsCost: up to $ 1,400
CT of the lungs is a painless diagnostic procedure that lasts from 10 to 30 minutes. Modern scanners provide high-quality 3D images of internal organs and pathological structures. This guarantees an accurate and quick diagnosis. Sometimes, doctors inject an iodine-containing contrast agent before the CT to improve the visualization of the tissues. A contrast agent can cause a feeling of warmth throughout the body for a few minutes. If you are allergic to iodine, warn your doctor before administering the medicine.
Computed tomography of the lungs does not require hospitalization.
BronchoscopyBronchoscopy is the examination of the inner surface of the bronchial tubes with a flexible probe called bronchoscope. The procedure is usually performed under local anesthesia, so the patient does not feel pain. Bronchoscopy is very important because it provides an opportunity not only to examine the bronchi, but also to collect tumor samples. Ultrasound (EBUS) bronchoscopes are sometimes used, combining high-quality endoscopic imaging and sonography. A previously performed CT or PET / CT scan will make the study more accurate using these sophisticated techniques.
The patient is not allowed to eat and drink a few hours before the procedure. Shortly before bronchoscopy, a sedative may be given to reduce discomfort. The procedure usually takes about 15 minutes, after which you can return home.
Avoid food and drink for at least an hour after the test, until the anesthetic has passed completely. Doctors do not recommend driving a car for 24 hours.
Fine needle lung biopsyCost: up to $ 2000
Sometimes a long thin needle is used to collect samples. This procedure is usually controlled by computed tomography (CT), which directs the doctor right to the tumor. Thanks to effective local anesthesia, patient feels only a slight discomfort. A fine-needle biopsy (FNA) takes only a few minutes, during which doctors collect tissue samples for microscopic examination of cancer cells.
The success of the procedure largely depends on the doctor’s experience, so it is recommended to undergo FNA only in well-known specialized clinics.
What to do when a tumor is found?
If doctors confirmed a lung tumor, you will need additional tests. Without them, it is impossible to objectively assess the spread of the tumor process, determine the type of cancer and prescribe the best treatment.
Endobronchial Ultrasound (EBUS)Cost: up to $ 2500
Endobronchial ultrasound is widely used to examine the tumor and adjacent lymph nodes. A thin flexible probe with an ultrasonic transducer is inserted through the mouth into the bronchi. The probe is small enough to reach the thinnest and most delicate bronchi. During the procedure, images are taken and tissue samples are collected from the lung and lymph nodes for microscopic examination (it is called transbronchial needle aspiration - TBNA). Biopsy causes discomfort, but is usually painless due to powerful anesthetics.
EBUS takes less than 1 hour, after which the patient can return home.
Endoscopic Ultrasound (EUS)EUS procedure looks similar to the previous one, but this time a flexible tube with an ultrasonic transducer (endoscope) is inserted into the patient's esophagus. Ultrasound allows doctor to visualize the mediastinum, revealing enlarged lymph nodes and cancer metastases in the center of the chest. If necessary, a biopsy is performed.
The examination takes less than an hour, without requiring hospitalization.
MediastinoscopyCost: $9000 or more
This is a minimally invasive procedure, during which surgeon examines the mediastinum and hilar lymph nodes with a special camera. Mediastinoscopy is performed in the operating theatre under general anesthesia. Short hospitalization is required. To examine the mediastinum, surgeon makes a small incision at the base of the neck, through which a thin flexible tube with a camera and miniature instruments is inserted.
VideothoracoscopyIn Israel, minimally-invasive technologies are used to diagnose lung cancer, replacing painful and risky surgery. Videothoracoscopy is simple, fast and safe. Through the tiny holes in the chest, surgeon inserts a camera, carefully examining the lungs and pleural cavity. Most patients can return home the day after the procedure. Videothoracoscopy is contraindicated only in heart and pulmonary insufficiency.
Positron emission tomography (PET / CT)Cost: up to $ 1800
PET / CT in Israel is available in all leading hospitals that treat medical tourists. This scan enhances the diagnostic capabilities of computed tomography with a special substance FDG that “highlights” the metabolically active malignant cells.
PET / CT scans are often used during the lung cancer treatment planning.
You should not eat six hours before the scan. Approximately one hour before PET / CT, a special radioactive agent is administered intravenously, which is absorbed by cancer cells. The procedure itself is completely painless and fast; it lasts from 30 to 90 minutes.
Magnetic resonance imaging of the lungCost: up to $ 1500
This test is similar to CT of the lungs, but instead of X-rays, MRI uses a magnetic field. Some patients are administered contrast agent to improve image quality. The duration of magnetic resonance imaging is about 30 minutes. MRI does not cause much discomfort. MRI also does not use harmful X-rays, providing high quality images of soft tissues and internal organs. There is one significant limitation: MRI scan is contraindicated in patients with an implanted pacemaker and other metal devices in the chest.
Pulmonary Functional Tests (PFT)Israeli surgeons pay great attention to surgical planning. It is necessary to determine the functions of the respiratory system. Pulmonary functional tests are physical exercises on special measuring equipment, performed under the supervision of a physician. PFT results are very important for further treatment.
Laboratory testsCost: $ 350 or more
Laboratory tests are necessary to determine malignant cells in sputum and tissue samples taken during biopsy. Additional blood and urine tests show the patient’s general health.
How long I have to wait for the diagnosis?The results of tests and procedures will be ready in a few days or weeks.
Going to diagnose lung cancer in Israel, we recommend you to take relatives for support. This is one of the world’s most visited countries with beautiful landscapes, healthy climate and friendly people. The best place to relax and escape from bad thoughts.
Top Lung Cancer Clinics in IsraelAccording to reviews of foreign medical tourists from around the world, we ranked the best medical institutions dealing with lung tumors:
• Hadassah Medical Center in Jerusalem
• Assuta Medical Center in Tel Aviv
• Medical Center Sourasky (Ichilov) in Tel Aviv
• Itzhak Rabin Medical Center in Petah Tikva
• Herzliya Medical Center in Herzliya
• Rambam Medical Center in Haifa
• Sheba Medical Center in Tel HaShomer
• Assaf Harofeh Medical Center near Tel Aviv
• Soroka Medical Center in Beersheba
• Elisha Hospital in Haifa
All clinics listed above are equipped with the latest technology. They have international certificates and offer modern and safe procedures in the field of onco-pulmonology.
Lung cancer treatment options in IsraelTreatment includes surgery, chemotherapy, radiotherapy, and highly selective targeted agents including immunotherapy. The latter is especially useful in inoperable SCLC.
The declared lung cancer treatment cost is $ 22,000-50000, depending on the case.
Treatment planningAs a rule, the treatment planning is carried out by a team of experts from different fields of medicine who monitor the patient’s condition 24/7 and make collective decisions. This multidisciplinary approach, coupled with modern technologies, allowed leading Israeli hospitals to achieve impressive clinical results. Over 50% of patients with lung cancer stage I live more than five years, but in some subgroups this figure reaches 90%.
Specialists involved in treatment planning:
• thoracic surgeon
• medical oncologist
• radiation oncologist
• general practitioner
• pathologist, etc.
If you smoke, be sure to quit! Smoking may interfere with cancer treatment. If there are two equally effective strategies, doctors will offer the patient to make a choice according to individual wishes and financial opportunities. Don’t be afraid to ask questions about any aspect of therapy and possible side effects.
Many patients fear to start lung cancer treatment due to “terrible” side effects. This was true half a century ago. Today, most side effects can be easily controlled with medications, sophisticated neurostimulators, and physiotherapy. No medication or procedure in Israeli clinics is used without informed consent.
Before you receive any treatment, the doctor will tell you about its goals and ask you to sign a form stating that you agree to the proposed therapy.
Surgical treatment of lung cancer in IsraelCost: $ 10,000-50000
Currently, it is impossible to completely destroy cancer by radiation or drugs. The only way to cure lung cancer is surgery, but not every patient is suitable for surgical treatment. It depends on the tumor type, its size and patient’s health status. Lung tumor removal is a difficult procedure, so the patient must be in good physical condition. In the case of NSCLC, surgical treatment is offered in the early stages of the disease (stage I or II, sometimes stage III). In the case of small cell lung cancer (SCLS), surgical intervention is rarely recommended, because its cells are usually found in distant organs at the time of diagnosis.
Tumor resection is performed in different ways. It can be open (thoracotomy) or keyhole (thoracoscopy). Surgeons may perform segmentectomy, lobectomy and pneumonectomy (complete removal of the lung).
In the first case, the surgeon opens the chest, sometimes cutting the ribs to access the tumor. After open surgery, there remains a scar of 10–20 centimeters long in the chest. Thoracotomy means long hospital stay and recovery.
Unlike the first method, video-assisted thoracoscopic surgery (VATS) is a minimally invasive intervention performed through 2 cm incisions on the chest. Modern tools allow the surgeon to cope with most tasks without open access.
This shortens the recovery period and reduces cosmetic defects.
During surgery, the surgeon removes the lymph nodes for lab test. Determining the extent of cancer cells in the lymph nodes dictates further treatment tactics, including the appointment of adjuvant chemotherapy or radiation therapy. If there are no complications, the patient is discharged from the hospital for 3-7 days. The first weeks you need to visit the doctor regularly to make sure that your lungs are working normally. Antibiotics may be administered to prevent postoperative infection.
Radiofrequency ablation of the tumorCost: about $ 12,500
RFA is a relatively new method that uses high-frequency radio waves to heat tumors. Radiofrequency ablation is particularly suitable for patients with the early stages of cancer, as well as for inoperable patients. This is a minimally invasive procedure that can be performed without general anesthesia.
Photodynamic Therapy (PDT)Photodynamic therapy of lung cancer is another alternative to surgery, which is currently being actively studied in many oncological diseases. Israeli clinics use PDT relatively rarely, leaving this option for inoperable patients. The method is based on the photodynamic effect when light is applied to sensitized cells.
Lung cancer chemotherapy in IsraelThe cost is $ 4,000-12,000 for one course
Chemotherapy for small cell lung cancer (SCLC) is one of the main options, since these tumors spread rapidly and rarely respond to surgical treatment. In NSCLC, chemo can be administered before surgery, as well as after removal, to reduce the risk of recurrence, control disease, alleviate symptoms, and improve quality of life. After surgery, some patients require adjuvant chemotherapy in the early stages. It is also used to control lung cancer, which cannot be surgically removed (including stage IV).
Cytotoxic drugs are administered intravenously or in tablets (orally). Chemo is usually prescribed in cycles – for several days of treatment, followed by a long period of rest.
Chemotherapy drugs for lung cancerThe main regimen involves the simultaneous administration of platinum-based agents (cisplatin, carboplatin) in combination with one of the following chemotherapeutic drugs:
• Gemcitabine (Gemzar)
• Etoposide (Etoposide-Teva)
• Vinorelbine (Navelbine)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Pemetrexed (Alimta)
Careful laboratory monitoring and application of the most modern scientifically proven treatment regimens is the key to safe and effective treatment. Dosages and number of cycles obtained depends on the type of malignant tumor and clinical response. Some cytostatic agents can be taken at home; other chemotherapy regimens require hospital stay. Chemo is often combined with other methods, such as radiotherapy and surgery.
Possible side effects of chemotherapy include:
• Susceptibility to infections: the suppression of the bone marrow by cytotoxic agents causes low levels of leukocytes (neutropenia), which is observed seven days after the start of therapy and gradually disappears 10-14 days after the last dose.
• Bruises and bleeding: low platelet level impairs blood clotting, so even minor injuries can be resulted in bleeding and hematomas.
• Anemia: during treatment, a low red blood cell count is observed. Anemia is manifested by weakness and fatigue, shortness of breath, pallor of the skin.
• Nausea and vomiting: this side effect of chemotherapy occurs within a few days, but doctors use effective drugs against nausea and vomiting that completely block or significantly reduce them.
• Mouth Pain: some medicines damage the mucous membrane, contributing to the formation of painful sores in the mouth. Treatment is symptomatic.
• Hair loss: damage to the hair follicles during treatment causes hair loss on the scalp; sometimes patients lose eyebrows and eyelashes. To protect the hair, Israeli clinics use special cooling caps, which limit the damage of follicles.
• Tingling and numbness: these side effects are caused by peripheral nerves damage. During chemotherapy course, patients may find it difficult to move their fingers, they experience tingling in the hands and feet. Recovery takes several months after discontinuation of drugs.
• Hearing problems: cisplatin can cause tinnitus and impair certain sounds perception. Hearing loss is sometimes observed after taking high doses and prolonged cisplatin cycles.
• Infertility: chemotherapy affects fertility, which should be discussed with doctor. Patients should use contraception, because cytostatics penetrate into the sperm and the egg, damaging genetic material.
Lung cancer radiation therapy in IsraelThe cost of treatment is $ 4,200-28,000, depending on the method.
High-energy rays successfully destroy rapidly dividing malignant cells. The main thing is to provide maximum protection to the surrounding healthy cells and tissues. Local oncologists have greatly succeeded in this area. Although there is no proton therapy center in Israel yet (plans for its construction were approved by the authorities in 2012), local clinics invest huge amounts of money in advanced foreign equipment and the development of own technologies. Stereotactic radiosurgery, CyberKnife, IMRT – patients can get everything here.
Lung cancer radiotherapy is carried out in a specialized hospital unit. The number of procedures and the duration of treatment are determined individually, depending on the stage of the disease, the specific goal of therapy and other factors.
Use of radiotherapy for non-small cell lung cancer (NSCLC):
• To cure the disease at an early stage
• To reduce the chance of recurrence after surgery
• To control cancer symptoms in the later stages
• To improve the effect of chemotherapy
Use of radiotherapy for small cell lung cancer (SCLC):
• Controlling tumor growth
• Brain irradiation to prevent metastasis
• Metastatic cancer palliative treatment
Types of radiation therapyIrradiation is delivered to the tumor in different ways. Sometimes the rays are directed through the body (external radiotherapy, EXBT). In other cases, the radiation source is implanted into a tumor, which is called brachytherapy. External radiotherapy is available in almost all major hospitals in Israel. The key to successful and safe exposure is thorough computer planning using computed tomography. Modern devices are able to purposefully irradiate the marked area, carefully bypassing healthy tissue. Internal irradiation (brachytherapy) is used when a tumor blocks one of the airways and causes disintegration of the lung. During treatment, a thin tube (catheter) will be temporarily inserted into the lung with a bronchoscope. A source of radiation is placed near the tumor to limit damage to healthy tissue.
Preventive irradiation of the brain is recommended for SCLC, since its microscopic cells often penetrate into the central nervous system and form metastases. Irradiation of the brain is always associated with severe side effects, but it is a reasonable risk.
Possible side effects of radiation therapy:
• Inflammation of the esophagus and difficulty swallowing
• Weakness and fatigue for several weeks
• Increased sensitivity of the skin and mucous membranes
• Loss of chest hair, sometimes irreversible
Among the long-term side effects of treatment, doctors pay attention to the thickening (fibrotic changes) of the lung tissue. Fibrosis can manifest as shortness of breath and chronic cough. Other complications are narrowing of the esophagus, bone fractures.
Targeted therapy for lung cancer in IsraelTargeted therapy (also called biological therapy) selectively destroys malignant tumors, stopping their growth and development by blocking specific receptors. Unlike standard chemotherapy, biological drugs are highly selective, and therefore safer.
Anti-EGFR Lung Cancer TherapyReceptors on the surface of malignant cells are equipped with endothelial growth factor receptors – special proteins that encourage them to grow and develop rapidly. In recent years, EGFR inhibitors have been developed. They bind EGF cell receptors slowing down tumor growth.
Before administering anti-EGFR therapy, doctors perform a biopsy and examine tumor cells for the presence of EGFR mutations. Not all patients benefit from this therapy.
EGFR inhibitors used in Israel:
• Afatinib (Gilotrif)
• Gefitinib (Iressa)
• Osimertinib (Tagrisso)
• Erlotinib (Tarceva)
These drugs are administered orally in the form of tablets. Side effects are usually minor. These include diarrhea, rash, nausea and fatigue.
ALK inhibitors in NSCLC treatmentThese targeted drugs are designed to treat ALK-positive non-small cell lung cancer (NSCLC). Anaplastic lymphoma kinase (ALK) is one of the tyrosine kinase proteins that are involved in the spread of malignant cells and cancer blood vessels growth. ALK inhibitors stop this process, prolonging the life of patients.
The following ALK inhibitors are available in Israel:
• Crizotinib (Xalkori)
• Ceritinib (Zykadia)
• Alectinib (Alecensa)
VEGF inhibitors in lung cancer treatmentVEGF inhibitor bevacizumab (Avastin) approved in most countries is also available in Israeli hospitals. This targeted agent inhibits angiogenesis disrupting malignant growth (blood vessels formation that is required in tumor growth). Bevacizumab is a monoclonal antibody that specifically binds to VEGF protein, a factor in the growth of blood vessels. Studies have shown that VEGF inhibitor in combination with standard chemotherapy significantly improves treatment outcomes. Decreased blood supply makes the tumor more vulnerable to cytotoxic drugs, stops its growth and prevents the formation of distant metastases.
Lung cancer immunotherapy in IsraelNivolumab (Opdivo) is used after chemotherapy. It activates the immune system of patients to fight malignant cells. Nivolumab blocks the PD-1 protein on T-lymphocytes, restoring their ability to identify and destroy tumors. Nibolumab is a solution administered intravenously within 60 minutes. Possible side effects include weakness, fatigue, diarrhea, nausea, vomiting, and skin changes.
Pembrolizumab (Keytruda) is another drug for immunotherapy of lung cancer that blocks PD-1 protein. Pembrolizumab is most effective for malignancies with laboratory confirmed PD-1 receptor activity. Keytruda is administered intravenously.
Side effects include weakness, diarrhea, nausea and vomiting, skin reactions.
Targeted cancer therapy affordability in Israel and the USAAs you can see, medications and procedures in local hospitals are much cheaper compared to the United States. A study conducted in 2016 by Daniel Goldstein and colleagues showed a huge gap in terms of the availability of targeted drugs between two countries.
Approximate cost of monthly doses of drugs (Israel vs USA):
• Bevacizumab (VEGF inhibitor): 820 mg costs $ 2,600 vs $ 6,800
• Erlotinib (EGFR inhibitor): 4200 mg costs $ 2,450 vs $ 9950
• Trastuzumab (HER2 inhibitor): 656 mg costs $ 1,800 vs $ 6800
• Pemetrexed (chemo): 1240 mg costs $ 4000 vs $ 9000
Lung cancer treatment in Israel is almost three times cheaper. This is especially attractive when considering the affordability of medical procedures and accommodation.
© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator