Лечение рака поджелудочной железы

For the successful treatment of pancreatic cancer  , the participation of highly qualified medical specialists is required. Herzliya Medical Center private clinic provides its patients with the opportunity to undergo diagnosis and treatment at leading Israeli oncologists and oncologists. The latest developments, modern equipment and invaluable experience of doctors — all this allows you to fight the disease as efficiently as possible.

Pancreas cancer

This disease is characterized by the growth of cancer cells in the tissues of the pancreas. This type of cancer is considered one of the most difficult to cure and, at the moment, leads the list of cancers that lead to death. It is very important to be able to recognize the symptoms of pancreatic cancer and consult a doctor in time.

Pancreatic Cancer Symptoms

• Inexplicable scabies — as a rule, when suddenly inexplicable scabies appears, the patient consults a dermatologist. It is important to visualize the bile ducts and pancreas in order to exclude the presence of a tumor that does not give bile passage;
• Back pain — a pancreatic tumor can cause girdle pain in the back. If the pain appeared suddenly and inexplicably, it is important to insist on taking a picture of the pancreas, and not just an x-ray of the spine;
• Jaundice — a tumor in the head of the pancreas can lead to obstructive jaundice, due to the location of the organ close to the bile ducts;
• Sudden and unexplained diabetes — a sudden inexplicable development of diabetes in a patient who does not have any risk factors may be a sign of a pancreatic tumor;
• Additional symptoms include deep vein thrombosis (TBH), an increase in the gallbladder, a digestive disorder and a general decrease in appetite;

In any case, it is important to immediately consult a doctor for an extensive diagnosis of cancer.

Pancreatic Cancer Diagnosis

Diagnosis of pancreatic cancer is, in fact, a relatively simple and quick process with the necessary advanced equipment. At Herzliya Medical Center, the diagnosis consists of the following procedures:

• CT scan according to a special protocol for imaging the pancreas — a special protocol involves thin sections of 2.5 mm and intravenous administration of a contrast medium. Based on these thin sections, the hepatobiliary surgeon will be able to assess how widespread the tumor is and whether it affects the vital vessels (superior mesenteric artery and superior mesenteric vein);
  If the tumor is operable, the patient will be sent for preoperative blood tests and try to remove the tumor. In this case, a biopsy is not necessary and a pathological analysis of the tumor will be performed after its removal;
• Biopsy — if the tumor at the time of its detection is too large, the patient will be prescribed a course of chemotherapy in order to reduce it. This approach is called downstaging (literally — lowering the stage) and requires a histological determination of the type of tumor. Clinical oncologists at the Herzliya Clinic prescribe an individual chemotherapy regimen for each patient. A biopsy is usually performed using endoscopic ultrasound;
• PET-CT — in case the tumor is inoperable (that is, it has spread beyond the pancreas or encircles the superior mesenteric artery too much), the patient may be given a PET-CT scan to determine the prevalence of metastases before further treatment;
• Oncomarkers — if pancreatic cancer is suspected, the analysis of oncomarkers alone is not indicative and is not an accurate diagnostic method. But for a complete clinical picture, with suspected pancreatic cancer, the level of CEA and CA19-9 tumor markers is checked.

Pancreatic Cancer Treatment in Israel

In the process of deciding on the optimal treatment plan for pancreatic cancer in Israel, experts from various fields take part. The «Herzliya Medical Center» practices the MDT (multi-discipline-team) approach, in which a consultation of oncologists, surgeons and radiologists is convened. The details of a particular case are considered individually and together as a clinical picture. This approach guarantees the selection of the optimal treatment method.

In the early stages of the disease, if a CT scan showed that the tumor is operable, the treatment for pancreatic cancer in Israel is to remove the tumor. In case of tumors of the body or tail of the pancreas that do not affect the vessels, the operation is performed by the laparoscopic method, distal pancreatectomy (removal of the tail and body of the pancreas) and splenectomy (removal of the spleen) are performed.

In the case of tumors of the head of the gland or vascular involvement, a laparotomy is necessary. After the operation, the patient receives drainage tubes for the pancreas. The tubes are removed only when the liquid ceases to stand out.

Unfortunately, pancreatic cancer recurs very often, so after removing the tumor, the patient is prescribed several courses of chemotherapy, with a total duration of 4-6 months, in order to reduce the risk of tumor re-development.

If the tumor wraps around the superior mesenteric vein by no more than 180 degrees, the surgeon may try to remove the affected part of the vein with subsequent reconstruction. During the reconstruction, an artificial graft, a graft from the jugular vein of the patient himself or an anastomosis can be used. Reconstruction of the mesenteric vein is successful in more than 80% of cases.

If the tumor touches the superior mesenteric artery or encircles the superior mesenteric vein 180 degrees or more, it is considered inoperable. Pancreatic cancer is also considered inoperable if the tumor has metastasized to other organs. In such cases, a palliative surgery can be performed to eliminate complications of the disease, for example, obstruction of the bile ducts.

Often, in the treatment of inoperable pancreatic cancer in Israel at advanced stages, a chemotherapy course is prescribed according to the FOLFIRINOX protocol, which consists of leucovorin, 5-FU, irinotecan and eloxatin. Treatment often includes radiation therapy.

Additional treatments for pancreatic cancer: Whipple surgery and Nano-knife

Operation Whipple. Whipple’s operation is performed if the tumor has not spread beyond the pancreas. It consists in partial or complete resection of a diseased organ (pancreatectomy), partial resection of the stomach and small intestine, removal of the gallbladder and bile duct, and dissection of regional lymph nodes. To reconstruct the patency of the gastrointestinal tract and restore digestive function, the surgeon imposes an anastomosis — forms an artificial channel connecting the stomach to the small intestine. Another anastomosis serves to enter the intestines of bile, which is necessary for the digestion process. Whipple’s operation is considered one of the most complicated procedures in surgery, the duration of the procedure is on average 5 hours, followed by hospitalization from 6 to 10 days.

Cancer treatment in Israel is carried out using the most advanced techniques and antitumor drugs, providing for possible side effects and protecting the patient from them.

Our surgeons

Herzliya Medical Center — a leading center for cancer surgery, bringing together under its roof the best specialists in the treatment of pancreatic cancer in Israel. Among our hepatobiliary surgeons are: Barack Bar-Zakay, who studied and advanced in France and the United States. Today he is the head of the Department of Hepatobiliary Surgery at the Kaplan Medical Center.