Treatment of pancreatic cancer in Israel

Dr. Liat AppelbaumDirector of Ultrasound Institute

The only effective treatment for pancreatic cancer is removal of the tumor followed by chemotherapy or radiotherapy.

In 2018, for the first time in Israel, the Hadassah Clinic replaced a complex surgery to remove pancreatic tumors and cysts with a non-surgical, safe, ultra-precise, minimally invasive radiofrequency ablation.

Surgery on the pancreas has always been very dangerous and required special skill, because both the bile duct and the pancreatic duct pass through here, damage to which can have very serious consequences. The new procedure helps to avoid all these risks.

Radiotherapy using alpha particles was introduced at the clinic in 2022. The clinic currently uses it to treat skin cancer, head and neck tumors, pancreatic cancer, and liver cancer.

The alpha-particle source, which has a much more powerful effect on the tumor tissue than photons, is placed inside the tumor. The alpha particles propagate only in the blood vessels of the tumor and do not travel to the surrounding healthy tissue, making treatment not only more effective, but also safer.

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Pancreatic cancer diagnostics in Israel

DISCOVERY MI PET-CT

Early detection and diagnosis of pancreatic cancer is essential for the best chances of successful treatment and improved outcomes, and these advanced diagnostic techniques play a key role in achieving this goal.

Since 2018, the Hadassah Hospital has been using the most accurate PET-CT machine in the country. Its sensitivity is 90% higher than that of the most modern devices. This allows tumors to be detected at the earliest stages and provides a more accurate picture of the nature of the tumor and its spread.

EUS is a minimally invasive procedure that involves inserting a small, flexible tube with an ultrasound probe into the mouth and down into the stomach and duodenum. This allows for high-quality images of the pancreas, surrounding tissue, and nearby lymph nodes to be obtained. EUS can also be used to obtain tissue samples from suspicious areas of the pancreas for biopsy, which can be performed at the same time as the procedure.

ERCP is another diagnostic tool used at the Hadassah Clinic for the evaluation of pancreatic cancer. This procedure involves the insertion of a long, flexible tube with a camera and a light on the end through the mouth and down into the stomach and duodenum. ERCP is used to diagnose and treat problems with the bile ducts, which can be a sign of pancreatic cancer. This procedure can also be used to take tissue samples from the bile ducts or pancreas for biopsy.

Biopsy is a crucial step in the diagnosis of pancreatic cancer. Tissue samples can be obtained during EUS or ERCP, or through a needle biopsy guided by imaging techniques such as CT or MRI. The tissue is then examined under a microscope by a pathologist, who can confirm the presence of cancer and provide information on the type and stage of the disease. Biopsy results can also guide treatment decisions and provide important prognostic information.

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Treatment of pancreatic cancer in Israel

In addition to surgical options, the Hadassah Clinic also offers several non-surgical treatments for pancreatic cancer, including radiotherapy, chemotherapy, and targeted therapy. These treatments can be used alone or in combination with surgery to improve outcomes.

Ablation

Radiofrequency ablation

Ablation is a minimally invasive procedure that is increasingly being used to treat pancreatic cancer. This technique involves the destruction of cancerous tissue using heat, cold, or chemicals. When performed under ultrasound monitoring, ablation is an effective way to remove pancreatic tumors while minimizing damage to surrounding healthy tissue.

During an ablation procedure, a thin, flexible probe is inserted into the pancreas under ultrasound guidance. The probe is then used to deliver heat or cold energy, or chemicals directly to the tumor, destroying the cancerous cells. This technique can be used in patients who are not candidates for surgery due to advanced age, poor overall health, or the location of the tumor.

One of the key advantages of ablation under ultrasound monitoring is its precision. Ultrasound imaging allows doctors to visualize the tumor and surrounding tissue in real-time, ensuring that the ablation probe is accurately placed and minimizing the risk of damage to nearby structures such as blood vessels or organs.

Another benefit of ablation is its minimal invasiveness, which reduces the risk of complications and shortens recovery time compared to traditional surgery. Patients undergoing ablation can often go home the same day or the following day and return to normal activities within a few days.

The clinic’s specialists were trained in this procedure by Professor Marc Berthey, an expert recognized throughout Western Europe and head of the gastroenterology department at the renowned AP-HM hospital (Marseille, France).

Of course, ablation is not suitable for all patients: there are restrictions on the size of the tumor as well as a number of other factors.

Most tumors removed by ablation are neuroendocrine. In Israel, the Hadassah Hospital ranks first in the diagnosis and treatment of such tumors: in 2018, the NEO division was awarded “center of excellence” status by the European Society of Neuroendocrine Tumors (ENETS) for its achievements.

Surgery

The Hadassah Clinic offers a range of surgical options for the treatment of pancreatic cancer, including Whipple’s surgery, distal pancreatectomy, and total pancreatectomy. Intraoperative radiotherapy can be used in select cases to improve outcomes. The appropriate treatment plan will depend on several factors, and the experienced team at the Hadassah Clinic is well-equipped to develop a personalized treatment plan for each patient.

Whipple’s surgery, also known as pancreaticoduodenectomy, is a complex procedure that involves the removal of the head of the pancreas, the duodenum, a portion of the stomach, the gallbladder, and the bile duct. This procedure is typically used for tumors located in the head of the pancreas. Whipple’s surgery can be a challenging operation with a long recovery time, but it can be curative in some cases.

Distal pancreatectomy involves the removal of the body and tail of the pancreas, leaving the head intact. This procedure is used for tumors located in the body or tail of the pancreas. Distal pancreatectomy is a simpler procedure than Whipple’s surgery and may have a shorter recovery time.

Total pancreatectomy involves the removal of the entire pancreas and may be necessary in cases where the cancer has spread throughout the organ. This procedure is typically reserved for advanced cases of pancreatic cancer and is associated with a significant risk of diabetes and other complications.

Intraoperative radiotherapy (IORT) is a specialized technique that involves delivering a high dose of radiation directly to the tumor bed during surgery. This approach can be used in cases where the tumor is close to critical structures such as blood vessels or nerves, making it difficult to deliver a high dose of radiation safely. IORT can improve outcomes in certain cases, and the Hadassah Clinic has the expertise and technology to perform this procedure safely and effectively.

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Radiotherapy

Alpha DaRT Radiotherapy

Radiotherapy involves the use of high-energy radiation to kill cancer cells. External beam radiation therapy (EBRT) is the most common type of radiotherapy used for pancreatic cancer and involves directing a beam of radiation from outside the body onto the tumor.

The Hadassah Clinic has state-of-the-art equipment and experienced radiation oncologists who can deliver precise, high-dose radiotherapy to the tumor while minimizing damage to surrounding healthy tissue.

Chemotherapy

Chemotherapy can be administered intravenously or orally and may be used before or after surgery. The Hadassah Clinic offers the latest chemotherapy drugs and has a team of experienced oncologists who can develop personalized treatment plans for each patient.

Targeted therapy

This treatment targets specific molecules or pathways that are involved in the growth and spread of cancer cells. This approach can be more effective and less toxic than traditional chemotherapy, as it targets only the cancer cells and not healthy cells. The Hadassah Clinic has access to the latest targeted therapy drugs and can incorporate this treatment into a patient’s overall treatment plan.

How to come to the Hadassah Clinic for medical treatment?

In order to come to the Hadassah Clinic in Jerusalem, Israel for medical treatment, first contact Hadassah University Hospital staff to discuss your medical condition and treatment options.

Once you have received confirmation that the clinic can provide the necessary medical care, you should obtain a medical visa from the Israeli embassy in your country and make travel arrangements. Finally, ensure that you have all necessary medical records and documents before you depart for the clinic.

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