The clinic Assuta in the treatment of esophageal cancer in Israel with a patient interacts team of highly qualified doctors, among them - oncologists, surgeons, radiation therapists, rehabilitation specialists, nutritionists and other uses such innovative techniques as.:
- Minimally invasive surgery.
- Endoscopic surgery.
- Targeted therapy.
In addition, it is offered participation in clinical trials.
This is the basic method of treatment of esophageal cancer in Israel, when the disease has not affected lymph nodes. Most often performed esophagectomy, there are several approaches to its implementation. The doctor can recommend the most appropriate technique based on the location of the tumor and the presence / absence of secondary lesions.
Typically, the removal step comprises:
- Part or all of the esophagus;
- gastric segment;
- lymph nodes, located close to malignant lesions.
The preserved portion of the stomach tighten up and connected to the segment of the esophagus. It may be necessary to the feeding tube while the patient will not be able to make their own food.
Potential side effects of surgery include:
- leakage from the anastomosis;
- difficulty swallowing;
- digestive problems.
Chemotherapy is the treatment of esophageal cancer in Israel
Chemotherapy uses cytotoxic drugs in the fight against cancer by stopping its growth. Chemotherapy drugs moving through the bloodstream, reach cancer cells throughout the body.
For their administration into the body using an injection, drip (for intravenous injection) pump.
The list of possible questions that can ask the doctor at the clinic Assuta:
- Why in this case must be treated with cytotoxic drugs?
- What is the task of chemotherapy in a particular case?
- Are there alternatives?
- How is the treatment?
- Will I have a central line?
- What are the long-term and short-term side effects?
- What measures can be taken to alleviate the adverse effects of therapy?
- How long is the course?
- Chemotherapy will be conducted on an outpatient basis or require hospitalization?
Chemotherapy for cancer of the esophagus before surgery
Most patients who undergo surgical treatment of esophageal cancer, prescribed therapy with cytostatics. Clinical studies indicate that such treatment reduces the risk of recurrence at the 2 and 3 stages of the disease. Also, this treatment reduces the size of malignancy to the surgeon it was easier to remove. Often used scheme of drugs - cisplatin and fluorouracil (5-FU).
Chemotherapy for cancer of the esophagus before and after surgery
When the diagnosis of adenocarcinoma of the lower esophagus or location of the tumor in the esophageal-gastric junction may require chemotherapy before and after surgery (perioperative). It reduces the size of the tumor and the chances of the disease returning.
The combination of chemotherapy and radiotherapy
This form of treatment otherwise called chemoradiation. Sometimes it is given before surgery to reduce the risk of recurrence.
If the tumor has not spread to the process, but it is difficult to remove, chemoradiotherapy can reduce the tumor. Thereafter, the surgeon will remove it. This kind of treatment of esophageal cancer is effective prior to surgery in adenocarcinoma and squamous type of cancer.
When the operation can not be carried out or the patient does not give consent, as an independent method, doctors may recommend chemoradiotherapy, especially in squamous cell carcinoma of the upper third of the esophagus. Many experts believe this situation, the results of this treatment are as effective as the operation.
Chemoradiotherapy - quite intensive treatment. It is difficult to complete the course, and the side effects will be more severe than individually. When deciding whether a doctor will assess the state of health, whether the patient is able to move it.
Chemotherapy for esophageal cancer to control symptoms
At occurrence of metastasis in the body recommended chemotherapy to reduce tumor mass, growth retardation disease, loosening its manifestations, such as difficulty in swallowing. Treatment is primarily a combination of cytostatics. They will enter the body through the dropper and tablets. The main task - to relieve the patient to unwanted effects of therapy do not outweigh the benefits.
When adenocarcinoma esophageal-gastric junction or the large number of HER2 protein on the surface of cancer cells may be recommended targeted therapy - herceptin cytostatics.
If chemotherapy is ineffective, it may be prompted to laser treatment of esophageal cancer or stent placement to food passed down the esophagus.
Prior chemotherapy should consult with your doctor about taking a dietary supplement, herbs, herbal products. They may reduce the effectiveness of cytotoxic drugs.
chemotherapy drugs in esophageal cancer
Doctors use several different drugs and their combinations in the treatment of this disease. Results above, when using several drugs.
Selection depends on the type of esophageal cancer and the stage of the disease. Based on the research, it was found that certain cytotoxic agents are more effective in the treatment of adenocarcinoma, the other - in the treatment of squamous cell carcinoma. If chemotherapy is considered at later stages of cancer of the esophagus, it is selected so that there was minimal side effects.
- Fluorouracil, also called 5-FU.
- Capecitabine, another name - Xeloda.
- Cisplatin and carboplatin are sometimes used.
- Paclitaxel (Taxol).
Usually assigned a combination of 2 or 3 drugs - combination, e.g., ECF includes epirubicin, cisplatin and fluorouracil.
Some of the most common combinations for adenocarcinoma of the esophagus:
- CF or CX - cisplatin and fluorouracil or capecitabine and cisplatin.
- ECF - epirubicin, cisplatin and fluorouracil.
- EOX - epirubicin, oxaliplatin and capecitabine.
Squamous esophageal cancer recommend cisplatin and fluorouracil (CF) or cisplatin and capecitabine (CX).
Also, Israeli doctors use irinotecan and vinorelbine.
For administration of most drugs used dropper. Fluorouracil need for receiving a catheter and a central continuous supply of drug in the body for several days or weeks. Pump (pump) is installed in the clinic.
Capecitabine - it fluorouracil tablets. Taking pills for patients is often easier. Twice a day, the drug is prescribed for a course of treatment for esophageal cancer in Israel.
Most combinations of cytotoxic drugs given in an outpatient setting is sometimes required to stay overnight.
Side effects of chemotherapy in esophageal cancer
cytostatics treatment causes some side effects, which are caused by several factors:
- prescribed medications;
- dosage of medication;
- Individual reactions.
Not every patient has all the possible side effects. Some people react more than others. And different drugs have various undesirable consequences. Therefore, there is no way to accurately predict. Most side effects last for a few days while continuing medication intake. List some common undesirable manifestations:
- Reducing the number of blood cells.
- Increased risk of infection.
- Thinning hair or hair loss.
Chemotherapy and radiotherapy
Irradiation may be assigned at the same time as chemotherapy. The method is called chemoradiation. Irradiation give every weekday 5 weeks.
Apply different methods of chemoradiotherapy. The patient may receive chemotherapy during the course of irradiation. Sometimes, the patient goes through several cycles of chemotherapy before starting radiotherapy.
Chemoradiotherapy before surgery may designate or instead. Applied several different chemotherapeutic drugs. Most often recommend a combination of cisplatin and Xeloda.
Cisplatin is given intravenously in an outpatient setting is sometimes required to stay overnight. Capecitabine tablets taken twice a day, the entire course of therapy.
Radiotherapy is conducted each weekday 5 weeks. Most patients receive chemoradiotherapy for esophageal cancer in an outpatient setting, but because of the negative effects of the treatment sometimes requires hospitalization.
Side effects of chemoradiotherapy
This type of treatment is quite intensive. You may experience adverse effects of chemotherapy and radiation - a decrease of blood cells, fatigue, redness of the skin in the treatment area, nausea, sore throat, weight loss.
The availability of effective drugs to eliminate this symptom.
The majority of patients who undergo this treatment, sore throat. Swallowing problems may be aggravated in the course of continued therapy. Doctor will prescribe painkillers, may recommend a while solid foods to replace the liquid. Some patients use the pump for analgesics, it provides a stable dose of medication and comfort during treatment for esophageal cancer.
The loss of body weight
Because of problems with swallowing, patients may lose weight. Do not worry too much about it. In the event of a serious situation, the doctor may suggest placement of feeding tube (gastrostomy or eyunostomicheskoy) as long as the patient does not recover after the treatment, and will not eat normally.
Radiation therapy in esophageal cancer
Radiation therapy uses ionizing radiation in the treatment of malignant disease.
Assuta Hospital Doctors often use radiotherapy. It can be recommended a combination of cytotoxic drugs and radiation to cure the disease, as well as prior to surgery or instead of it. Most often this treatment is prescribed instead of esophageal cancer surgery in the upper third of the esophagus lesions, especially when SCC.
If the disease is diagnosed at later stages, irradiation is also used. It can reduce the volume of the tumor and reduce symptoms that provoke tumor.
Primarily using an external radiation therapy for cancer of the esophagus, but in addition to it are sometimes recommended inner - brachytherapy when the radiation source is positioned within the esophagus.
During the reception, a doctor at the clinic Assuta, you can ask any questions. A sample list:
- Why in this case, it is recommended radiotherapy?
- What is its task?
- The need for remote radiotherapy or brachytherapy, or both types?
- Is there a choice?
- How long will the treatment take place?
- What are the possible - short-term and long-term side effects?
- Do I need any special diet for this period of time?
- Can the patient to take some measures to alleviate the side effects?
External exposure is carried out at the Institute of radiotherapy clinic Assuta primarily ambulatory. Duration of the course depends on the goals of treatment for esophageal cancer in Israel - to cure a disease or alleviate its symptoms.
Radiotherapy is aimed at getting rid of oesophageal cancer, suggests a course duration of 4 to 6 weeks. The radiation oncologist will calculate the total dose of radiation and divides it into small procedures - faction.
On the day might get a single fraction treatment is carried out on weekdays, until the total dose given. Doctors prescribe radiotherapy so as to balance the side effects of treatment with the effect of esophageal cancer.
Radiation therapy for controlling symptoms of the disease involves obtaining a smaller number of fractions. This may be one treatment a day for a few days or a series of treatments with an interval of several days between each.
Planning radiation therapy in esophageal cancer
Before you begin treatment team of radiation oncologists carefully plan the external radiotherapy. Calculate the total dose and the determined processing area. The planning process can take from several minutes to two hours. It will be held on CT or MRI to pinpoint the tumor and the structures around it.
Processing area can be marked by special marks (tiny tattoos).
If struck by an upper esophageal segment, you will need a mask to save a fixed position while being treated.
Several days may be required to solve the final details of the plan.
Receiving radiation therapy for esophageal cancer in Assuta
Linear accelerators are large. The machine can be locked in one position or to rotate around the body, providing irradiation from different directions. The doctor explains to the patient in detail what will happen. The session takes about one minute to several. It is important to maintain the desired position.
Brachytherapy in the treatment of esophageal cancer in Israel
Brachytherapy - a type of radiotherapy, when radiation source is placed inside the body and not from the outside - from a linear accelerator. This type of treatment is not used as often as external radiotherapy. Usually brachytherapy is used to slow the progression of the disease rather than cure it. For example, after stent placement, to facilitate the process of swallowing.
The radioactive source is placed inside the gullet for some time. This provides a high radiation dose directly to the tumor. Since the radiation is bad spreads through the body tissue surrounding healthy areas are much smaller dose to be seriously affected. irradiation area is limited to about 1 cm from the radioactive source.
Two methods for providing such treatment for esophageal cancer in Israel by the endoscope or nasogastric tube.
The doctor may place a radioactive source during an endoscopy. Endoscope, a flexible telescope-like, is lowered into the throat. It is equipped with a light and camera, so the doctor sees the interior region. Before the procedure, the patient is given a sedative or a light anesthetic. The radioactive source is installed near the tumor. Radioactive material is sealed inside the tube can therefore not leak out.
By the same type used by nasogastric tube. It is administered through the nose, is lowered down the back of the throat to the stomach. Establish a radioactive source and remove the probe.
Side effects of radiation therapy
Side effects caused by treatment zone. In the treatment of esophageal cancer, this area may extend to the middle of the chest.
Adverse effects include:
- short-term pain during swallowing;
- dry sore throat that impedes swallowing process;
- reddening of the skin in the treatment zone;
- loss of body hair in the treatment area.
Such events usually occur gradually throughout the course, may be amplified to an end. The patient is usually able to eat only liquid or very soft foods by the end of therapy.
If you experience nausea, appointed antiemetic drugs. Changes in the skin of most people slightly, some noted more problems.
Side effects of radiation therapy in the treatment of symptoms
If the body any secondary outbreaks of the disease, but several treatments can be scheduled. Therefore, it is likely that any undesirable effects will be absent. Radiation therapy is aimed at improving the status and well-being.
Side effects of brachytherapy
Brachytherapy also has certain undesirable consequences of treatment. It can cause pain when swallowing. Sometimes there are ulcers in the esophagus. Doctor will prescribe pain medicine. During this period recommend a liquid or very soft foods.
Long-term side effects of radiation therapy
Both internal and external radiation therapy can cause long-term effects. For example, trigger a narrowing or stricture of the esophagus. This will create a difficulty in swallowing. It can be carried out minor surgery (dilation), to expand the body. This is usually done during endoscopy.
esophageal cancer targeted therapy
Targeted drugs help the body to control the growth of malignant cells.
Herceptin in the treatment of metastatic cancer of the esophagus
When adenocarcinoma esophageal-gastric junction that has spread to other parts of the body, can be recommended trastuzumab (herceptin) as a primary treatment for esophageal cancer. It is prescribed with chemotherapy.
Herceptin is effective, if only on the surface of cancer cells is a large amount of protein her2. Before the appointment of therapy conducted genetic tests.
Herceptin is administered in combination with cytostatics - capecitabine or cisplatin and fluorouracil. Herceptin can not cure metastatic cancer, but, according to tests, increases the survival of patients. The drug is administered intravenously every three weeks. This treatment of esophageal cancer continues until disease controls.
Side effects of Herceptin
Among the most common undesirable manifestations note: fatigue, diarrhea, allergic reactions, skin rashes. These symptoms can be controlled with medication.
Herceptin can cause heart damage, so regular tests to find out how well the body.
Other targeted therapy drugs
Researchers are studying the drug Avastin (bevacizumab) in the treatment of esophageal cancer, including esophageal-gastric junction.
Prices for the treatment of esophageal cancer in Israel
- Consultation with a specialist - $ 600.
- Gastroscopy with a check for Helicobacter pylori - 1080 dollars.
- Complete blood count - 260 dollars.
- PET-CT - 1670 dollars.
- Biochemical analysis - 280 dollars.
- Investigation of materials (biopsy) - 680 fraction.
- Research for tumor markers - 240 dollars.
- Esophagoscopy - 370 dollars.
- US - 340 dollars.
- Target Now - 9250 dollars.
- Chemotherapy - 1180 dollars.
- Medication - 360 dollars.
- Radiation therapy - 140 dollars.
- Esophagectomy - 59 thousand dollars.
- Complete resection - 75 thousand dollars.
- Partial resection - 59 thousand dollars.
Reviews for the treatment of esophageal cancer in Israel
Myl'nikov Igor, 37 years old
"In the treatment in Israel we went two years ago. I drove to his father. It was already pretty bad at the time, but no one was going to give up. The Assuta decided to go because they knew about its reputation and know that in Israel, the chances of a good outcome is much greater. And the money was less than in the same fly America. All this I write to say thank you to all the doctors who work there. Sensitive and qualified personnel, technology and medicine have helped to put on his father's feet. Thanks"