Pancreatic cancer treatment in Israel: diagnosis, therapy and surgery

Every year, hundreds of medical tourists from around the world benefit from quality and affordable pancreatic cancer treatment in Israel.

More than 500 Israelis develop pancreatic cancer each year, which is why this problem catches the attention of local researchers and medical community.

It is considered the fourth most common cause of death, after breast cancer, lung cancer, and colorectal cancer.

This disease begins to develop in the tissues of the pancreas.

This vital gland secretes enzymes that aid digestion. In addition, pancreatic hormones (insulin) regulate glucose metabolism in the body.

In pancreatic cancer, uncontrolled cell growth occurs.

They continue to divide, taking nutrients from the body and poisoning it with toxic metabolic products. These malignant cells can spread to other organs of the body and form secondary tumors, the so-called metastases.

Some tumors arise not in the pancreas itself, but in the duodenum and bile ducts that pass through it. In fact, most tumors in the area develop into ducts that pass through the pancreas. Most cancers in humans develop in the mucous membrane of such ducts. They are called adenocarcinomas.

In 5–10% of patients, the tumor develops from other elements, such as endocrine cells or connective tissue cells. These tumors are less aggressive than “ordinary” pancreatic cancer.

Pancreatic cancer is considered one of the most deadly tumors. The chances of full recovery are very small, even if the diagnosis was made at an early stage. Pancreatic cancer has a tendency to spread quickly, and therefore it is rarely found in stage I. This fact, along with the structural features and location of the pancreas, causes a technical complexity of treatment and high mortality.

It is a particularly silent, symptom-free cancer in its early stages. Symptoms usually appear only at a relatively late stage, when surgical removal of the tumor is no longer possible.

In Israel, 85% of patients at the time of diagnosis have metastases or a large inoperable tumor, in which surgical intervention is impossible. These patients cannot be completely cured, and therefore doctors try to maintain their life and alleviate the symptoms as long as possible.

16-22% of patients undergo surgical intervention. Finally, only about 3-5% of patients are completely cured. This paints a terrible picture.

Best pancreatic cancer centers in Israel

In Israel, there are more than a dozen medical centers that provide world class oncological care to foreign patients. When choosing the best clinic for the treatment of pancreatic cancer, we recommend considering such factors as the presence of specialized specialists in this field and experience in treating this disease. The presence of unique (experimental) options, such as new chemotherapy or immunotherapy regimens, is also an important advantage.

Here are the best medical centers that deal with this disease:

• Sourasky Medical Center (Tel Aviv)
• Rambam Medical Center (Haifa)
• Hadassah Medical Center (Jerusalem)
• Assuta Medical Center (Tel Aviv)
• Medical Center Herzliya

It is important to note that the cost of medical services in Israeli clinics is usually much lower compared with most Western countries. The cost of accommodation for patients and their relatives for the period of diagnosis and treatment is also much lower compared to the US.

What are the causes of pancreatic cancer?

Unlike the past, we now know that there are populations that are more likely to develop pancreatic cancer.

In patients with chronic pancreatitis, alcoholics, people with familial adenomatous polyposis and a predisposition to a large number of abnormal moles on the body, the risk is increased. In addition, this malignant disease is part of rare genetic syndromes. For example, BRCA1 or BRCA2 gene carriers are at risk.

Symptoms and methods of diagnosis of pancreatic cancer

Usually, pancreatic cancer has some minor early signs that patients and doctors tend to ignore. These are non-specific signs that are rarely associated with a deadly disease.

Among the possible early signs of the disease:

• Rapid weight loss ("successful" diet)
• Suddenly developed diabetes mellitus in old age
• Worsening of diabetes despite weight loss.
• Abdominal pain and discomfort
• Unexplained weakness
• Diarrhea or constipation

The combination of two or more of the above symptoms should be suspicious. Contact a specialist for examination as soon as possible. Sudden jaundice is another symptom that may indicate obstruction of the bile duct by a growing neoplasm. Very dark urine, light feces, yellow skin, and severe itching need attention.

The cost of consulting an experienced oncologist or surgeon in Israel is $ 400-600.

If your doctor suspects that you have pancreatic cancer, he can order the following tests:

• Abdominal ultrasound exam
• Endoscopic ultrasound: $2500-3500
• Computed tomography: $600-1300 per one area
• Magnetic resonance imaging: $1000-1600 per one area
• PET / CT scan for metastases: starting $1400
• Endoscopic retrograde cholangiopancreatography
• Biopsy of the pancreas: starting $1500
• Extended blood test: starting $60

Other diagnostic tests may be required to determine the spread of cancer to neighboring organs. The entire process of diagnostics and treatment planning can take several days.

According to Israeli doctors, the best and most affordable method for diagnosing pancreatic cancer is abdominal CT scan with contrast, in which even a small (few millimeters) tumors are detected. Routine blood tests are not effective in diagnosis, except in cases of jaundice. There are blood tumor markers that may indicate the disease such as CEA and CA19-9 cancer antigens.

Current pancreatic cancer treatment options in Israel

The choice of treatment depends on the stage and exact location of the tumor, as well as on the age, health condition, and personal preferences of the patient regarding treatment. The primary goal is to completely eliminate the tumor, if possible. If this is not possible, doctors will focus on preventing the spread of cancer and extending the life. When cancer is diagnosed at a very late stage (multiple metastasis), the doctor may recommend palliative treatment to alleviate the suffering.

The only way to cure the disease is surgical removal of the tumor.

Surgery

There are several types of procedure: Whipple’s surgery, left-sided pancreatic resection, limited removal of the affected segment or complete removal of the pancreas. Only a very small percentage of pancreatic tumors are resectable. It means that not all patients have a good chance of a complete cure. If the cancer has already spread beyond the pancreas to other organs, lymph nodes, or blood vessels, surgery is usually considered ineffective.

Unfortunately, in some cases it is necessary to remove the pancreas completely to save a life. This surgery is dangerous and difficult, and requires great skill from the surgeon.

Subsequent treatment is also difficult and expensive for the patients.

Surgery in Israel means an excellent professional level and affordable prices. For example, the Whipple procedure at Assuta Medical Center costs 35-40 thousand dollars. For comparison, a similar operation in the United States can cost more than 100 thousand dollars.

Surgery for pancreatic cancer was previously associated with 20% mortality. Today, thanks to the experience gained over the years, the mortality rate is only 1-3%. This is comparable to other large-scale surgical interventions.

An experienced surgical team (at least 16–20 surgeries per year) ensures optimal result. Studies have shown that surgery to remove a pancreatic tumor tends to cause fewer complications when performed by an experienced surgeons. Feel free to ask your doctor for information about experience in the area of pancreatic tumor removal.

If you have any doubts, be sure to get a second opinion in other Israeli hospital.

Why is the surgery dangerous?

Inside the pancreas, as well as next to it are the large blood vessels of the intestine and liver. The tumor is located very close and sometimes involves these blood vessels. The most dangerous part of the operation is the separation of the pancreas from the blood vessels and their preservation. Restoring the connection of the pancreas, bile ducts and intestines also requires great skill.

Other treatments

Other treatments play a secondary role in pancreatic cancer.



They are used mainly in the later stages of the disease, and sometimes complement the surgical treatment of some exocrine tumors:

• Radiation therapy: starting $10,000
• Irreversible electroporation (Nanoknife): starting $20,000
• Systemic chemotherapy (FOLFIRINOX, Gemcitabine, Cisplatin, etc)
• Targeted drug therapy (Erlotinib (Tarceva) and others)

As for chemotherapy, the leading Israeli clinics offer almost all the same innovative treatment options as the American cancer centers. But much cheaper.

Clinical trials

Clinical trials are aimed at studying new medicines and treatment approaches, such as new tumor resection techniques or types of radiation therapy, gene therapy, etc. If these treatments prove more effective or safer than existing protocols, they will be used for all patients.

Clinical trials cannot guarantee recovery and may have unexpected side effects.

On the other hand, the Israeli Ministry of Health is closely monitoring clinical trials to ensure that they are carried out at the highest level of safety. In addition, clinical trials can provide access to innovative treatments that are not yet available in other clinics.

Promising areas of pancreatic cancer treatment in Israel that continue to be studied:

• Drugs that prevent the growth of blood vessels of a cancer (angiogenesis inhibitors)
• Personalized vaccines against pancreatic cancer (a type of immunotherapy).

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator