Treatment of breast cancer in Israel

Breast cancer is a malignant tumor that strikes the glandular breast tissue. Today, breast cancer is one of the most common types of female cancer.

Each year more than 1 million new cases of the disease are diagnosed in the world. It is natural that such disease requires prompt diagnosis and effective treatment in Israel, because the mammary tumors are direct threat to human health and life.

Types of malignant breast tumors

Currently, specialists differentiate six types of breast cancer:

• Ductal carcinoma (invasive, non-invasive) - the tumor between the milk ducts, is the most common type of cancer.
• Intraductal carcinoma differs from ductal tumor as it arises from the cells inside the ducts, in which are circulated secretory fluids.
• Medullary carcinoma of breast is the most malignant type of breast tumors with rapid development and metastasis. Woman can die within several months.
• Lobular carcinoma in situ (non-invasive, invasive) - a tumor that affects the intralobular dusts (alveolar vesicles), the second most common type of breast cancer, which is diagnosed at 25% of patients.
• Glandular cancer (adenocarcinoma) is localized in the glands of the breast and can be in any body segment, so radical surgery is required to treat it.
• Paget cancer - a rare form of malignant breast tumors with localization on the nipple.

These types in turn are divided into several histologic subtypes (about 30 kinds). Another type of malignant breast tumor is a lymphoma that is not relevant to the determination of breast cancer and needs treatment protocols, which are used in case of lymphomas.

Diagnosis of breast cancer in Israel

Diagnostics needed to confirm or refute the breast cancer is as follows:

First patient passes the inspection at mammalogy oncologist. Then specialist conducts palpation of the breast and armpits to detect suspicious and seal formation.

According to the results of the inspection mammography and breast ultrasound will be appointed.

Mammography is of two kinds:

• Digital - image is not created as a result of X-ray investigation, but using a special detector;
• Computer - image processing using a special program.

There are other more informative methods of inspection for young women with high breast density, such as ultrasound.

If ultrasound and mammography shows the presence of tumors are appointed biopsy and laboratory tests.

Laboratory tests include the following methods:

• Verification of HER-2 protein growth or immunostaining;

• Study of hormone receptors, checking for sensitivity to estrogen and progesterone. When there will be reaction may be assigned hormone treatment;
• A blood test for the presence of tumor markers (specific substances that appear in malignant processes). In breast cancer, they are CA 15-3 and CEA, as well as the BRCA. Their high content in blood indicates the presence of metastasis;
• CTC analysis to determine the presence of circulating cancer cells in the blood, which allows to forecast the growth of the tumor and to choose the right course of treatment;
• Measurement and calculation of tumor tissue DNA (DNA-cytometry) for evaluating cancer aggressiveness. Carried out by treatment with a digital code of malignant cells under a microscope.

Biopsy is called histological examination of samples of cellular material or tissue from a tumor.

The following methods are used in the diagnosis:

• FNA (fine needle biopsy) is used in cases when tumors are movable with a special syringe that extracts a sample of tumor cells. This procedure is painless and is performed on an outpatient basis. For more accurate movements are applied ultrasonic or X-ray navigation;
• TRUCUT (nuclear-needle biopsy) - a tissue sample is obtained using a hollow needle. The procedure is performed under local anesthesia;
• Biopsy using vacuum suction or Mammoth technology - ultrasound sensor is inserted in cancerous tissue through micro-incisions;
• Sentinel lymph node biopsy to test the possible infiltration of the tumor.

In addition, can be assigned the following examinations:

• Magnetic resonance imaging of the breast  is performed to locate and determine the number of lesions;
• Positron emission tomography  to check for the presence of metastases and distant tumors;

Earlier in the diagnosis of breast cancer were used:

• Computer tomography (rarely is used nowadays);
• Liver ultrasonography (as breast cancer often metastasizes in liver);
• Isotope scan of the skeleton.

Today, instead of these examinations is used PET-CT, which allows to see any metastases.

Some of the above diagnostic methods are used not only to detect disease, but also to verify the results of the treatment of breast cancer in Israel.

Treatment of breast cancer in Israel - methods

In treatment of breast cancer in Israel are used the local, systemic and combined methods. Local method supposes an impact on affected areas and includes surgery and radiation therapy. When there are diagnosed metastases is applied a systematic approach that affects the entire body and covers chemotherapy, biological, hormonal treatment.

It should be noted that nowadays i the combined therapy (using different techniques) shows good results not only in the fight against tumors in the mammary gland, but also in the treatment of gastric cancer, throat cancer, and so forth.

Treatment options depend on the type of the disease:

Ductal carcinoma:

• Lumpectomy + radiotherapy, probably, chemotherapy.
• Mastectomy + probably, hormone therapy, chemotherapy. Also at 1-3 stages can be carried out immunotherapy – Gertsiptin is recommended. It is recommended in all cases where the HER-2 receptor is positive +++ (three pluses) if ++ pluses, then is performed FISH procedure. Using FISH specialists find out if HER-2 is positive in this situation (i.e., closer to +++ or still closer to ++). If it is closer to +++, the patient takes Gertsiptin during the first year, in parallel with chemotherapy and then without it. The drug is administered through an IV.

Lobular carcinoma:

• Expectant therapy: regular checkups, mammograms, biopsies.
• Hormonal treatment with Tamoxifen.

Medullary carcinoma:

• Radical mastectomy with lymph node dissection.
• Several courses of chemotherapy.
• Radiation therapy.

Glandular cancer:

• Radical mastectomy with removal of lymph nodes.
• Chemotherapy using modern drugs (Mitoxantrone, Mitomycin), antitumor antibiotics.
• Immunotherapy.

Treatment of breast cancer in I, II, III A stages

• Lumpectomy and lymph node dissection.
• Modified radical mastectomy with breast reconstruction.
• Biopsy of the sentinel lymph node followed by surgery.

The adjuvant therapy (post-operative treatment to reduce the risk of relapse) may include the following types of breast cancer treatment in Israel:

• Chemotherapy;
• Targeted therapy (Herceptin under positive HER-2) in combination with chemotherapy;
• Radiotherapy of lymph nodes after modified radical mastectomy;
• Hormone therapy.

Treatment of breast cancer in III B and III C stages

Neoadjuvant chemotherapy followed by surgery (lumpectomy or mastectomy) with lymph node dissection + radiotherapy. As additional methods are assigned chemotherapy, hormone therapy, or a complex effect.

Treatment of breast cancer in stage IV

• Hormone therapy and / or chemotherapy.
• Targeted therapy in combination with chemotherapy.
• Radiation therapy and / or palliative surgery to relieve pain and other symptoms.
• Treatment with bisphosphonates - drugs that prevent bone loss in cancer invasion into the bone.
• Participation in clinical trials of new chemotherapy, hormonal therapy, targeted therapy drugs.
• Clinical trials of new combinations of treatment, including targeted therapy, hormone therapy and chemotherapy.

Surgical treatment of breast cancer in Israel

The decision to use the surgical treatment of breast cancer in Israel depends on many factors: the stage and type of cancer. After gathering all the necessary information doctors determine what result will give surgical treatment.

For the surgical treatment of breast cancer operations are applied several options:

• Mastectomy - a technique that involves the full removal of the breast:
  • Modified radical mastectomy - the removal of the affected tissues glands (the vast majority of the skin, including the nipple and areola), part of tissues of the chest wall, axillary lymph nodes.
  • Simple mastectomy - removal of the breast without excision of local axillary lymph nodes (lymph node dissection) with sentinel lymph node biopsy to test the tumor invasion process in this area.
• Lumpectomy involves the removal of a malignant tumor and a small amount of surrounding healthy tissue.
• The Israeli hospitals there is a possibility of breast reconstruction after surgery for breast cancer in Israel, the possible types:
  • Espandernaya dermatenziya.
  • Implantation of the prosthetic own soft tissues.
  • Method patchwork plastics.
  • Methods patchwork plastic TRAM Flap.

Radiation therapy

Radiation therapy applies ionizing radiation for the treatment of breast cancer in Israel. It is a very effective way to destroy the remaining cancer cells after surgery. It reduces the risk of recurrence by about 70%. Radiation therapy is relatively easy to carry, and its side effects are generally on the the treated area. Types of radiation therapy used in Israel in the treatment of breast cancer are the following:

• External exposure is the most common type of radiotherapy treatment which is usually administered after tumor removal. This type of treatment is conducted on an outpatient basis five days a week for 5 - 7 weeks, depending on the particular situation;
• Internal radiation used in the treatment involves the placement of a radioactive source inside the tumor by several catheters or via a device called MammoSite (balloon catheter, the innovative technique). This type of therapy reduces treatment time, irradiates only the affected area;
• Intraoperative radiation therapy - a relatively new type of radiation used in the treatment, which is given during surgery.

Chemotherapy is used:

• at early invasive type, to get rid of any cancerous cells that may remain after surgery and reduce the risk of relapse.
• at the later stages as a palliative treatment to alleviate the symptoms and improve quality of life.
• in some cases, before the operation.

Several chemotherapeutic agents are generally used in Israel to treat breast cancer:

• Cytoxan;
• Adriamycin;
• Methotrexate;
• 5-fluorouracil (5-FU);
• Taxol
• Cyclophosphamide;

The drugs are administered in different combinations and courses. The most common treatment of the breast cancer in Israel is carried out every two or three weeks intravenously or orally.

In the later stages of breast cancer new drugs proved the effectiveness, such as:

• Taxol;
• ABRAXANE;
• Taxotere;
• Adriamycin;

Other used in chemotherapy drugs are: Gemzar, Navelbina and Ixempra.

Test Oncotype DX breast will provide additional information which helps the doctors to decide the use of chemotherapy in Israel for the treatment of breast cancer.

Hormonal therapy

Hormone therapy drugs are prescribed only to treat hormone-positive breast cancer or its recurrence. Hormonal medications have an impact in two ways:

• reduce the level of the hormone estrogen in the body;
• block the action of estrogen on breast cancer cells.

Indications for hormone therapy:

• Reducing the risk of further development, when this risk is very high (healthy women).
• Reducing the risk of relapse in case of non-invasive breast cancer.
• Reducing the likelihood of disease after the return of primary treatment, including surgery, chemotherapy or radiation therapy.
• Reduction the tumor size in case of invasive cancer to other methods of treatment.
• Metastatic cancer.

Drugs used in the treatment: Tamoxifen, FARESTON, Arimidex, Femara, Zoladex, Halotestin.

In some cases the fallopian tubes and ovaries are surgically removed to treat hormone-positive breast cancer, or as a precaution against women with a very high risk of developing this type of cancer.

To recover from chemotherapy and radiation therapy helps supportive therapy, which involves the administration of drugs for the indicators of blood recovery. In a number of Israeli clinics have been used experimentally supplements, produced specifically for patients undergoing chemotherapy and radiation therapy.

Immunotherapy

Immunotherapy is used to remove breast cancer and prevent recurrence.

One of the common drugs is Herceptin, whose antibody bind to the receptor protein HER-2  selectively affect tumor cells and do not affect healthy.

Another remedy is Xeloda, which itself does not have the ability to destroy cancer cells. This compound goes through three phases of transformation in the human body. The last phase during which the final product is synthesized and has cytotoxic activity, takes place in the tumor itself.

It turns into a kind of factory, which produces a poison against itself. This increases the efficiency of the drug and reduces the total negative effect on the entire organism. This is new class of anti-cancer drugs and Xeloda is its sole representative yet.

At present, more and more oncologists believe that correction of immune disorders is the key to a successful fight against disease.

Find out the cost of treatment of breast cancer in Israel on our website.

For more information about the treatment of breast cancer in Israel please contact "Isramedic".