Department of Pediatric Oncology and Hematology in Israel
Children are a special category of patients, especially children who are faced with such problems as cancer. They need a special approach to diagnostic and treatment process, to care and create comfortable conditions for staying in medical institutions, not only in physical, but also in psychological aspects. Therefore, it is necessary for young patients to receive the necessary care in specialized departments staffed by highly qualified doctors and medical staff. One example of such a department is the Department of Pediatric Hematology and Oncology at Tel Aviv Medical Clinic.
Diseases of blood system in childhood are especially dangerous. According to statistics, hematology oncology problems are the number one cause of premature death among children and rank first among all malignant diseases of childhood.
Hematology and oncology in Israel today is at the highest stage of its development. Specialists in this field of medicine have achieved extremely high results in the early diagnosis and successful malignant diseases treatment of varying complexity degrees.
The department provides comprehensive treatment of hematology oncology diseases and other malignant tumors of various locations, for example, retinoblastoma, soft tissue and bone sarcoma, nephroblastoma, brain tumors, etc. The department has a whole multidisciplinary team, since several specialists are involved in process of diagnosing and treating children with cancer: oncologists, hematologists, chemotherapists, radiologists, neurosurgeons, orthopedic oncologists, rehabilitation specialists and other highly specialized doctors, if necessary. Also Bone Marrow Transplantation Clinic successfully operates on the basis of this department.
Departments
On the basis of Department of Pediatric Oncology and Hematology, several separate divisions function simultaneously:
- Hematology Oncology – hematologists of this profile are engaged in diagnostics and treatment of blood system malignant diseases (leukemia, aplastic anemia, lymphoma and others).
- Neuro-oncology – specializes in treatment and diagnostics of benign and malignant tumors of brain and spinal cord, peripheral nerves.
- Ophthalmic Oncology – here children with eye cancer, for example, retinoblastoma, are treated and diagnosed.
- Urological Oncology – doctors of this profile provide comprehensive care to patients with kidney tumors (nephroblastoma, for example).
- Oncologic Orthopedics – here children with benign and malignant neoplasms of musculoskeletal system and soft tissues receive comprehensive and qualified care.
- Chemotherapy Department – here patients receive the necessary courses of polychemotherapy, targeted therapy, immunotherapy, etc.
- Radiation Department – here patients undergo the necessary diagnostic procedures, as well as courses of radiation therapy (distance or contact).
- Diagnostics Department is a modern department equipped with all the necessary equipment for an accurate diagnosis of oncological pathology.
- Pathohistological laboratory – pathomorphologists work here who study tissue samples after biopsy and establish an accurate diagnosis.
- Bone Marrow Transplantation Department – this is where young patients are prepared for the procedure, transplant itself and subsequent treatment.
- CART Therapy Department is an innovative unit where this type of treatment of hematology oncology diseases is carried out.
What diseases does Department of Pediatric Oncology and Hematology treat?
Diagnostic methods in pediatric oncology and hematology
Medical staff of Department of Pediatric Oncology and Hematology uses modern diagnostic methods, which allows us to make the most accurate diagnostics and, for example, carry out a successful bone marrow transplantation.
Developing an examination plan, the child’s age and individual needs are taken into account. All procedures are performed in the most possible gentle manner. If diagnostics requires invasive interventions, then all such manipulations are performed under sedation (medicated sleep) in order to avoid any pain in child, fear or other psychological discomfort.
All departments are equipped with excellent material and technical resources. Examinations of young patients are carried out using modern equipment. In particular, in clinic of hematology oncology, not only modern CT and MRI devices are widely used, but also innovative medical imaging equipment PET-CT, PET-MRI, functional MRI (fMRI), CT and MRI simulators for planning radiation therapy.
If a biopsy is necessary during diagnostic process, then samples of biological material are sent to best pathohistological laboratories. Thanks to such “molecular tests”, we are confident in diagnostics correctness and adequacy of further treatment regimen.
Thanks to modern and specialized equipment, diagnostics of oncological diseases at TAMC occurs quickly (which is very important for successfully disease overcoming) and accurately, thanks to work of an entire multidisciplinary team with extensive experience.
To establish a diagnosis, the entire arsenal of the latest laboratory and instrumental examination techniques is used:
- ultrasound diagnostics with color Dopplerography;
- general clinical, biochemical, hormonal examinations of blood, urine, tumor markers in blood of various tumor diseases;
- cytological and histological methods for tumor verification;
- radiologic examinations – digital radiography, computed tomography (CT) and magnetic resonance imaging (MRI), positron (or two-photon) emission tomography (PET);
- tumor biopsy;
- endoscopic examination techniques (fibro esophagoduodenogastroscopy, colonoscopy, laparoscopy, bronchoscopy, cystoscopy, etc.);
- radionuclide methods of organ scanning (scintigraphy).
Important!
75% of children diagnosed with cancer can be completely cured, giving them long, healthy and happy lives.
The only condition is making a diagnosis in early stages of disease and using modern and comprehensive approaches to treatment of these diseases. This is exactly what specialists from Department of Pediatric Oncology and Hematology at TAMC do.
Molecular diagnostics for malignant neoplasms (molecular genetic studies) is an important component of modern oncology and hematology. The direct cause of tumors development is a mutation in a certain gene, due to which it stops working correctly, and a cell with such a mutation acquires signs of malignancy and the ability to reproduce uncontrolledly and spread metastases.
The Foundation One molecular genetic test is an advanced complex for identifying mutations in a patient’s tumors for selection of individual targeted and immunotherapy. This allows us to make up a plan for the most effective treatment for each individual child, taking into account sensitivity of malignant cells to drugs. This treatment approach of malignant diseases is very effective and is called personalized oncology.
Why is such an accurate diagnostics needed in oncology? The fact is that an oncological diagnostics consists of following components: tumor name, its location and the stage of disease. Required type of treatment and its volume will depend on each given item. Therefore, before planning the necessary range of interventions, doctor must obtain an answer to all these questions. This is the only way treatment program will be complete and successful.
Modern treatment methods in pediatric oncology and hematology
General treatment principles of childhood tumor diseases are not much different from those in adult oncology. As a rule, treatment program is complex, that is, it includes immediately or sequentially a combination of two or more therapy methods. It all depends on specific diagnosis (as indicated above – t tumor he name, its location and stage of disease).
Surgical interventions
Surgery is one of the main and radical treatment methods in oncology. It is extremely rarely used as monotherapy (i.e. the only method of treating cancer); it is more often used in combination with other methods – chemotherapy, radiation.
The main principle of pediatric surgery that we adhere to in clinic is organ-saving interventions where this is truly possible. Our aim is not only to preserve babies life, but also its high quality. It is for this purpose that TAMC specialists actively use minimally invasive interventions, which also significantly reduces pain, speeds up recovery after surgery, and reduces the risk of postoperative complications.
Chemotherapy
This is malignant tumors treatment method by introducing medications into the body that stop the growth or reproduction of malignant cells. As a rule, it is used infrequently as monotherapy. Specialists combine chemotherapy with surgery (for example, before surgery to reduce the size of primary tumor and make it resectable, or after surgery to permanently destroy any malignant cells that may have remained after intervention). Sometimes chemotherapy can be used as an independent treatment method, for example, for hematology oncology diseases or for palliative purposes.
For cancer treatment, Department of Pediatric Oncology and Hematology at TAMC uses only original drugs from well-known European, Israeli and American manufacturers. Due to high quality of medicines, side effects risk is minimized.
Radiation therapy
This is a treatment method in which malignant cells are destroyed under the influence of ionizing radiation. It can be used as an independent treatment method or in combination with surgery and/or chemotherapy. Radiation therapy regimen is selected individually. We use only modern and safe equipment. Before the start of course, patient undergoes CT or MRI radiation simulation, which allows us to select and configure all the necessary parameters for external radiation therapy.
Immunotherapy
Also known as biological therapy. In this case, special substances are introduced into the body that teach our immune system to recognize and attack malignant cells. Targeted therapy is a type of biological therapy.
Targeted drugs are aimed specifically at cells of specific tumor. They are “trained” to block signals that promote tumor growth, or “set a command” for self-destruction of all such cells in human body.
Bone marrow transplantation
The main treatment method for many hematology oncology diseases – bone marrow transplantation – is carried out at the highest world standards. Israeli doctors have access to American and European databases containing information about potential donors. And if a family donor is not suitable for transplantation, this service is actively used to select an ideal donor-recipient pair. This significantly increases chances of successful procedure and further full recovery for our little patients.
Types of bone marrow transplantation:
- Autologous bone marrow transplantation is transplantation of patient’s own cells that have been previously selected. This procedure is used for certain diseases that are not based on a genetic factor. For example, before a course of high-dose chemotherapy, bone marrow stem cells are collected from patient, and after course of chemotherapy is completed, they are reintroduced into the body, thereby restoring normal blood cell production.
- Allogeneic transplantation – such a transplantation consists of injecting the patient with stem cells taken from a donor. This is the best method in malignant tumors of blood system treatment, especially those caused by genetics.
- Syngeneic transplantation – this type of transplantation involves the transfer of hematopoietic stem cells within a pair of twins.
CAR-T cell therapy
CAR-T cell therapy is a highly specialized and personalized treatment option that is not available in every cancer center around the world. Oncologists at TAMC clinic in Israel have been trained in leading medical institutions and they are pleased to offer their patients this innovative type of therapy.
When other treatments for blood cancer are ineffective, CAR-T cell therapy can achieve desired results and, in some cases, lead to permanent remission of disease. A significant advantage of this therapy type is that modifying CAR not only causes T cells to kill cancer, but also initiates their proliferation and growth. So after just one procedure, CAR-T cells remain in your body and continue to attack tumor for months or even years.
CAR-T cells are T cells that have been genetically modified in laboratory to bind to antigens on specific cancer cells. When a CAR T cell binds to cancer cell, immune system sends other types of cellular elements to destroy cancer cell and remove it from the body because it is foreign.
Currently, various clinical trials of drugs for CAR-T therapy for various forms of cancer are actively underway. One of the leaders in production of this biological medicine is pharmaceutical corporation Novartis. To date, the following drugs have been approved for CAR-T therapy of hematology oncology diseases:
- Acute lymphoblastic leukemia in adults and children.
- Acute myeloid leukemia in adults and children.
- Non-Hodgkin’s lymphoma in adults and children.
- Multiple myeloma.
After the course of treatment received, patient and his parents, if necessary, can receive psychological support, as well as a full range of rehabilitation measures. This approach significantly improves prognosis and reduces likelihood of long-term side effects from therapy.
Head of the Department of Pediatric Hemato-Oncology and Bone Marrow Transplantation
Pediatric oncohematologist.
Pediatrician
Oncologist, Head of the Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation
Director of the Department of Pediatric Hematology-Oncology at Maimonides Medical Center