Institute of Oncology
The second leading cause of morbidity and mortality worldwide is oncological disease.
As the incidence of cancer grows, so does oncological science; the spectrum of chemotherapeutic drugs changes daily, new receptor-based and biological treatment methods emerge, radiotherapy and brachytherapy (local irradiation) advance, and each new congress announces a groundbreaking discovery that turns yesterday’s oncology knowledge upside down. At Horev Medical Center’s Institute of Oncology, specialists work in the fields of nervous system oncology — neuro-oncologists, pulmonary system — oncopulmonologists, gastrointestinal — gastro-oncologists, and similarly — oncogynecologists, breast oncologists, orthopedic oncologists, and others.
Each patient at the Institute of Oncology is managed by two oncologists, and each patient hears two independent opinions, strengthening academic and clinical oversight. At the time of admission, patients who have no presentations or symptoms of oncological disease undergo special oncological screenings (blood tests for tumor markers, brain/neck/chest/abdominal/pelvic CT scans, mammography, gastroscopy, and colonoscopy). If no oncological disease is found, the patient is invited back in one year for follow-up preventive examinations.
If a tumor is detected in any organ system, oncologists determine a more detailed examination strategy; first and foremost, cellular and staging diagnoses must be established.
The cellular diagnosis is determined by biopsy. In each organ, tumors are diagnosed by specific methods: in the brain — stereotactic biopsy under MRI navigation, in the gastrointestinal tract — biopsy during gastroscopy, enteroscopy, and colonoscopy. In certain cases, endoscopic ultrasound is necessary, without which a tumor located within the stomach wall cannot be reached. Prostate tumors are examined by biopsy performed under transrectal (through the rectum) ultrasound guidance; liver, pancreatic, and lung tumors are identified using needle biopsy under CT guidance; bone marrow tumors, lymphomas, and leukemias require bone marrow biopsy.
Certain sarcomatous tumors are not suitable for needle biopsy, as the needle puncture can spread the tumor to surrounding tissues.
Once the tumor tissue is obtained, the "invisible front fighters" — pathologists — get to work. Their task is to provide oncologists with the keys to unlocking the histological diagnosis. Very often, standard methods do not lead to an answer about the specific type of tumor, and more precise immunohistochemical receptor studies must be performed to identify additional markers, without which either an accurate histological diagnosis is impossible, or the diagnosis will be inaccurate.
When oncologists receive the histological diagnosis and understand that the case involves carcinoma, sarcoma, or lymphoma, it is necessary to determine the exact disease stage, or in other words, the extent of its spread, which will fundamentally change the treatment strategy and determine whether the patient needs surgery, chemotherapy, or a combination of these methods.
To determine the disease stage, a full-body CT scan (brain, neck, chest, abdomen, pelvis) and isotope bone scan must be performed. Even if all studies show normal results and no metastatic tumor, the patient must undergo positron emission body scanning (PET), which detects metastatic foci at the cellular level when all other methods have proven ineffective.
Thus, firstly, PET is currently the most sensitive oncological marker, and secondly, the most accurate criterion for evaluating treatment effectiveness.
When after surgery, chemotherapy, or radiation, fibrosis, adhesions, and scars remain at the tumor site, PET will determine whether residual metastatic disease exists in the surgical area, in the tumor location, and in other parts of the body, since it is technically impossible to perform repeat biopsies from multiple body sites. PET is becoming the ideal diagnostic option for disease monitoring today.
Once biopsy methods are completed and the histological diagnosis is on the oncologist’s desk, in addition to the cellular diagnosis, there is a precise determination of the disease stage (this period takes 48–72 hours).
A consilium of oncologists, radiologists, pathologists, and those specialists who should be included in the discussion regarding the patient’s diagnosis and treatment determines the exact treatment strategy, establishes prognoses, and develops a plan of special measures that accompany oncological patients.
Each patient is prescribed special therapy to support immunity, renal and hepatic functions. Each patient receives a dietitian consultation to determine special nutrition providing adequate daily calories.
Each patient receives psychological support from a professional psychiatrist.
