Oncology in Tunisia

Oncology is the branch of medicine that focuses on the research, prevention, diagnosis, and treatment of cancer. A medical professional who specializes in diagnosing and treating people with cancer is called an oncologist.

An oncologist can design a treatment plan based on detailed pathology reports that shows the type of cancer the patient has, how much cancer has developed, how fast the cancer is likely to spread, and what parts of the patient's body are involved.

The field of oncology has three main areas, which include:

• Medical oncologists use chemotherapy, hormonal therapies, and other types of targeted treatments to treat cancer. Most people think of medical oncologist as their primary cancer doctor. Medical oncologists help monitor and maintain patients' well-being, as well as helping patients manage side effects. Often patients follow up with their medical oncologist once their treatment is complete.
• Surgical oncologists perform the surgical removal of the tumor and surrounding tissue. They will help patients prepare for and recover from any surgical procedure they undergo during their cancer treatment. If your primary doctor suspects that you have cancer, a surgical oncologist is likely one of the first doctors you see. Surgical oncologists can perform biopsies, which involves removing a small tissue sample to be checked for cancer cells.
• Radiation oncologists treat cancer using radiation therapy. They use high-energy photon beams to target and destroy cancer cells. Approximately one-half of all cancer patients will undergo radiation treatment during their cancer care.

Because most cancers are treated with a combination of therapies, you could see two or all three different oncologists during the course of your treatment.

Besides the three main areas, there are also several other areas of oncology. These include:

• Pediatric oncologists diagnose and treat cancer in children. Some types of cancer appear more often in children and teenagers, such as leukemia, brain tumors, osteosarcoma, and Ewing’s sarcoma. Some pediatric oncologists focus on conducting research on childhood cancers, while others specialize in certain types of cancer.
• Gynecologic oncologists treat cancers that affect women, such as cancer of the ovary, cervix, uterus, vagina, and vulva. Additionally, they also treat complicated gynecological conditions that are not cancerous, such as fibroid tumors and endometriosis.
• Hematologist-oncologists diagnoses and treats blood cancers, such as lymphoma, leukemia, and myeloma. They may also specialize in the management of solid tumors.

Oncologists usually work with a variety of other medical professionals, including pathologists, diagnostic radiologists, oncology nurses, and oncology social workers. They may also work with doctors from other areas of medicine, such as neurologists, dermatologists, or urologists.

What does Oncology Involve?

There are many types of procedures to treat cancer. The types of procedures that you receive will depend on the type of cancer you have and how advanced it is. Some people who have cancer will only have one treatment. However, most people have a combination of treatments, such as surgery with radiation therapy and/or chemotherapy. Below are the types of procedures to treat cancer:

Chemotherapy

Chemotherapy is a type of treatment that uses drugs to kill cancer cells in the body and prevent them from growing. The drugs can prevent cell division, target the food source of the cancer cells’ (the hormones and enzymes the cells need to grow), and trigger apoptosis (a process in which cancer cells kill themselves).

• Chemotherapy drugs can be given in several different ways, including.
• Oral – taken in a pill or capsule form.
• Intravenously – through an infusion into a vein.
• Shots – injected with a needle.
• Topical – applying creams or gels into the skin. This type is used to treat certain types of skin cancer.

Chemotherapy drugs can also be given directly to cancer or directly to an area of the body, such as the abdomen or central nervous system.

Immunotherapy

Immunotherapy, or biologic therapy, boosts your body’s natural defenses to fight cancer. It uses substances made by your own body, or in a laboratory, to improve or restore your immune system function. It can stop cancer from spreading to other parts of the body, stop or slow the growth of cancer cells, and help your immune system work better at destroying cancer cells.

There are several types of immunotherapy to treat cancer, including immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, treatment vaccines, and immune system modulators. Different types of immunotherapy may be given in different ways, such as intravenous (IV), oral, intravesical (directly into the bladder), or topical.

Targeted therapy

Targeted therapy uses drugs that are designed to specifically “target” cancer cells without affecting normal cells. It targets the cancer’s specific proteins, genes, or other tissue environment contributing to cancer survival and growth. These proteins and genes are found in cancer cells or in cells related to cancer growth.

The targeted drugs can block or turn off chemical signals that tell cancer cells when to divide and grow, stop making new blood vessels that feed cancer cells, change proteins within the cancer cells so the cells die, trigger the immune system to kill cancer cells, and carry toxins in the cancer cells to kill them.

• There are two types of targeted therapy:
• Small-molecule drugs, which is given through pills or capsules that you swallow
• Monoclonal antibodies, which are given through a needle in a blood vein.

Radiation Therapy

Radiation therapy uses intense energy beams to kill cancer cells and shrink tumors. It most often uses X-rays, but other types of energy, such as protons may also be used.

Radiation therapy can be done in two ways:

• External-beam radiation therapy – this type of radiation therapy delivers radiation from a machine outside the body. You will lie on a table, and the machine (called a linear accelerator) moves around you to deliver radiation from several different angles. It is a quick and painless procedure.
• Internal radiation therapy – also called brachytherapy, involves both temporary and permanent placement of radioactive sources in the body. During the placement of the radioactive sources, you will be given anesthesia.

Hormone therapy

Hormone therapy stops or slows the growth of cancer that uses hormones to grow. It works by blocking your body’s ability to produce hormones or interfere with how hormones behave in your body. It can reduce the chance that cancer will return by stopping or slowing its growth, as well as preventing or reducing symptoms in men with prostate cancer.

Hormone therapy is usually used to treat breast and prostate cancer. It can be taken in many ways, including orally, through an injection, and surgery.

Stem Cell Transplant

People whose blood-forming stem cells are damaged by the very high doses of radiation therapy or chemotherapy can undergo stem cell transplant to restore the cells. Blood-forming stem cells are vital since they grow into different types of blood cells that you need to be healthy. The stem cells will be given to you through an IV catheter. The process is very much like receiving a blood transfusion.

Surgical treatment

Surgical treatment for cancer is a procedure to remove cancer from your body. There are many types of surgeries to treat cancer, which differ based on the part of the body that requires surgery, the purpose of the surgery, the amount of tissue to be removed, and your preference. In general, the surgery can be open or minimally invasive.

• During open surgery, one large incision is made to remove the tumor, some healthy tissue, and some nearby lymph nodes.
• During minimally invasive surgery, a few tiny incisions are made instead of a large one. These incisions are made to insert a laparoscope (a long, thin tube with a camera on its end) and special surgical tools. The laparoscope allows your surgeon to see the inside of the body, and the surgical tools are used to remove the tumor and some healthy tissue.

How Long Should I Stay in Tunisia?

For chemotherapy, radiation therapy, immunotherapy, hormone therapy, and targeted therapy, the treatment schedule may vary. You may have treatment every day, week, or month. It may also be given in a cycle, which is a period of treatment followed by a period of rest to give your body a chance to recover. For surgical treatment, you may need to stay in the hospital for a few days, and you need to stay in Tunisia for at least 10 to 14 days. Your oncologist and/or medical tourism team will advise you on the length of stay in Tunisia.

What's the Recovery Time?

The type of procedure you undergo determines the recovery period. While you may be able to get back to your normal routine within 10 days after laparoscopic surgery, you may need to wait around 6 weeks to fully recover from open surgery. Your oncologist will give you a detailed recovery timeline.

What About Aftercare?

You will be given instructions on how to take care of yourself. Your surgeon or nurse will explain how to control your pain, how to take care of your wound, activities you can and cannot do, and how to spot signs of infections. You may also need to talk to a dietitian to help with eating problems caused by the treatment. You will need to attend follow-up checkups to monitor your condition.

What's the Success Rate?

Cancer survival has improved significantly due to constant advancement and improvements in the field of oncology, including improvement in treatments and screening (allowing for earlier diagnosis). Still, you need to be aware of the risks, such as infection, bleeding, nerve damage, fatigue, nausea, vomiting, and hair loss.

Are there Alternatives to Oncology?

There is no other alternative than to see an oncologist when it comes to cancer treatments. Some people may choose to undergo meditation, hypnosis, and acupuncture as well, usually to relieve the stress, anxiety, and pain that cancer can bring.

Oncology in and around Tunisia

About Tunisia

Tunisia is one of the few countries which can cater to everyone and it manages to combine climate, golden beaches, history, and shopping for an “all-around” experience. It has a high standard of healthcare and an excellent reputation for cosmetic surgery. Cosmetic and plastic surgeons are regulated by the Tunisian Ministry of Health and the private clinics have state-of-the-art equipment and English-speaking staff. Tunisia welcomes an ever-increasing number of medical tourists each year, many of whom travel for Oncology procedures. Medical Tourists travel from all across the globe, particularly from Europe and neighboring African countries with an inferior healthcare system. Popular medical tourism destinations outside of the capital, Tunis, include Sousse and Mahdia

Popular Parts of Tunisia

• Tunis, the country’s capital, is overflowing with a history that dates from the 4th Century BC. The city is divided into two parts, the old city known as the medina and the new city (or Ville nouvelle in French). Many tourists visit Tunis to see the Archaeological Site of Carthage which is also a UNESCO World Heritage Site. The beautiful Islamic architecture in medina also attracts many tourists to the city.
• Tozeur is known as a home to an enchanting desert oasis, which was a place to rest and refuel for caravans crossing the Sahara. Another main attraction in the city is the medina, where tourists can find lines of beautiful brick-patterned traditional dessert houses. Chott el Djerid, Sahara’s largest salt pan, is a popular day-trip destination.
• Sousse is located on the coast of the Mediterranean Sea. It offers good beaches with a clear blue sea. The city has been fought over by the Romans, Arabs, and Europeans, giving it a colorful history and culture. Sousse Archeological Museum is one of the most visited sites in the country; it has the second largest collection of mosaics in the world.
• Hammamet is the country’s original tourism resort. The city has beautiful gardens filled with oranges, lemons, and other citrus plants. It also has wonderful sandy beaches with crystal clear water. Just like any other city in Tunisia, this city is also brimming with interesting histories. Sites such as The Gafsa Museum and Bardo Museum will give insights about the Islamic faith and culture.
• Douz, also known as “the gateway to the Sahara.” Tourists who want to experience the Sahara Desert come to this city. Take a camel trip or a 4-wheel-drive into the Sahara or see the Museum of the Sahara that has an interesting collection portraying traditional Saharan life.

Weather and Climate in Tunisia

The North of Tunisia has a subtropical Mediterranean climate with mild rainy winters and hot summers. The South and inland areas have a tropical desert climate.

The weather is relatively comfortable throughout the year. Summer starts in June and lasts until August. The average temperature is between 28 °C to 32 °C with July and August being the hottest months. The heat is not as bad on the coast because of the seaside breeze. Be aware that July to September is the jellyfish season.

The heat decreases in autumn and the weather is somewhat more comfortable. There are occasional rain showers in September. The temperature in October can be like summer during day time, but cold at night. October has more rain than September. The season lasts for three months from September to November with an average temperature of around 19 °C to 29 °C.

The weather in winter can be uncertain. The average temperature is between 16 °C and 18 °C, but it can drop to 7 °C at night and below 0 °C in highlands and deserts and a clear sky is rare during this season.

Spring comes in March and the temperature can rise to 20 °C. Mornings and nights are cold; there is still a high probability of rains and thunderstorms at the end of this season.  

Getting Around in Tunisia

Tunisia has several international airports. The main airport is Tunic-Carthage International Airport. It has international connections with major European countries and the Middle East. The airport is the hub for Tunisair, Tunisair Express, and Nouvelair. Other airports that have international flights are Enfidha-Hammamet, Monastir Habib Bourguiba, Djerba-Zarzis, and Tabarka-Aïn Draham.

Taxis and buses are available to get to the city center from Tunis Airport. The SNT bus line departs every 30 minutes from the airport, the ticket costs less than 1 TND. There is also the TUT bus which departs every 15 minutes and is more luxurious and expensive.

Airport taxis are available at the airport taxi stand and are usually metered. Always make sure that the driver turns the meter on before riding the taxis. A journey to the city should cost around 5 TND. An extra cost will be added if you have baggage.

Getting around in Tunisia can be done by several transportation modes. Tunisair Express provides domestic flights between Tunis, Tozeur, Djerba, and Gabes. The Train is also available and the national train company in the country is SNCFT that runs modern and comfortable trains from Tunis to Sousse, Sfax, and Monastir. There are three classes of service that tourists can choose. The fare from Tunis to Sousse is between 6 to 10 TND. The long-distance bus is an economical option to travel between big cities such as Tunis, Hammamet, and Nabeul. The buses usually depart every 30 minutes.

Tourist Visas in Tunisia

Citizens of 97 countries (including Australia, China Singapore, the United States, and Russia) can visit and stay in Tunisia for up to 90 days without a visa. Other nationalities are advised to check with their local Tunisia embassy. Tunisia provides an online visa application for nationalities that needs a visa to enter. The eVisa will simplify the process of obtaining travel authorization to enter the country.

Additional Information

1. Local Currency: the local currency is the Tunisian dinar (TND). 1 USD converts to 2.61 TND.

2. Money & Payments: ATMs can be found in most cities and in all tourist areas. Many ATMs have withdrawal limits of 400 TND. Credit cards (MasterCard and Visa) are accepted in major cities and tourist areas. They can be used for shops, car hire, or top-end accommodation. Always make sure to carry cash if you want to travel outside major cities. Tipping is not necessary but will be appreciated.

3. Local Language: Arabic is the official language of Tunisia. French is very common due to the country’s former status as a French protectorate. English is still very limited except in the tourist areas and expensive hotels.

4. Local Culture and Religion: Islam is the major religion with 98% of the population identified as Muslim. There is a small group of Christian and Jews. Since most of the population is Muslim, always remember that the dress code is important in Tunisia.

5. Public Holidays: Tunisia celebrates major Islam holidays. The country hosts several annual festivals throughout the year such as The International Festival of the Sahara, Yasmine Hammamet Festival, and the International Festival of Carthage.