Ampullary & Duodenal Cancer Treatment in Israel

Duodenal carcinoma is the rarest of all digestive tract malignancies. It metastasizes in about 20% of cases (usually into the pancreas and omentum). This is why it is advised to perform all the necessary investigations as quickly as possible. The more detailed the information received is, the easier it will be for your treating oncologists to develop a duodenal cancer treatment protocol. It is also vital that you tell us the exact symptoms you are experiencing (such as jaundice, girdling pain, fever, nausea, vomiting, etc.).

Diagnosis

• Full blood workup (including CBC, CMP, electrolyte levels, lipid profile, tumour markers, pancreatic enzymes and HbA1c)
• Abdominal Ultrasound with Doppler
• PET-CT scan
• Abdominal MRI scan (with and without contrast material)
• Optional: MRCP scan (magnetic resonance cholangiopancreatography)
• Gastroscopy (under sedation – cost of procedure includes HP test; does not include biopsy)

These procedures will take 5 business days to complete. The work up will take place at Tel Aviv’s advanced Assuta Medical Center. An abdominal surgeon exam will take place after the results of the aforementioned investigations are ready.

Duodenal Cancer Treatment Protocols:

Surgical Treatment

The standard treatment method is a Whipple operation. Cost of procedure includes the following:

• Laparoscopic investigation under US guidance
• Whipple operation and 10 days of hospitalization at a semi-private room at Assuta Hospital’s Surgical Department.
• Express pathological study (to evaluate resection borders)
• Surgical materials (staplers, harmonic scalpels and bioadhesive)

It is advised you remain in Israel for approximately 14 days following your discharge from the hospital for follow-up care. During this period you will be examined by a gastric oncologist, who will determine the appropriate course of post-operative treatment (monitoring vs chemotherapy), and will also be referred to a clinical dietician.

Chemotherapy

If the disease is found to have spread beyond the regional lymph nodes into other organs and/or the omentum, you will be referred for neoadjuvant chemotherapy. Therapy protocols, which will be determined by leading Israeli specialists at Assuta, will depend on the exact type of tumour.

A PET/CT scan and abdominal surgeon’s exam will be scheduled following 3 to 6 cycles of chemotherapy to evaluate response to duodenal cancer treatment and assess the possibility of a surgical intervention.

Ampullary carcinoma

The term ampullary carcinoma (cancer of ampulla of Vater) refers to a number of malignant diseases, which develop at the point of insertion of the biliary duct into the duodenum. A tumour in this area can be primary (carcinoma, carcinoid, or adenocarcinoma) or secondary (spread of a duodenal malignancy). The main clinical symptoms of ampullary cancer are mechanical jaundice, itching, dyspepsia, vomiting, weight loss and dull pain.