Uterine cancer treatment and diagnosis in Israel

What is meant by uterine cancer

In most cases it is endometrial cancer, a tumour of the lining of the uterus. Uterine sarcomas, which arise from the muscle layer, are much rarer. The disease usually develops after the menopause; the risk is higher with obesity, diabetes, long-term oestrogen without progesterone and Lynch syndrome.

Not every growth in the uterus is malignant. Fibroids and endometriosis are benign conditions, whereas atypical endometrial hyperplasia is considered precancerous and needs treatment and follow-up.

Symptoms of uterine cancer

• bleeding or spotting after the menopause, the main warning sign;
• bleeding between periods or unusually heavy periods;
• watery or unusual discharge;
• pelvic pain, or pain during intercourse or when passing urine.

These complaints mostly have another cause, but any bleeding after the menopause is a reason to see a gynaecologist promptly.

Diagnosis in Israel

• Transvaginal ultrasound to measure the thickness of the endometrium.
• Endometrial biopsy or hysteroscopy with curettage, the only way to confirm the diagnosis. A cervical smear (Pap test) does not reliably detect endometrial cancer.
• Pathology review and molecular tests of the tumour (MMR/MSI, p53, POLE), which guide the choice of treatment.
• Pelvic MRI, CT or PET-CT to assess the extent of disease.

The final stage is established after surgery: I, tumour confined to the uterus; II, spread to the cervix; III, spread to nearby tissues or lymph nodes; IV, distant metastases.

Treatment methods

Surgery

The main treatment is removal of the uterus together with the fallopian tubes and ovaries, mostly by laparoscopic or robotic surgery. Lymph nodes are assessed with sentinel node mapping, which lowers the risk of leg swelling. At an early stage surgery alone is often enough.

Radiotherapy

Radiotherapy, either vaginal brachytherapy or external beam, is given after surgery when the risk of recurrence is higher, and instead of surgery when an operation is not possible.

Drug therapy

For advanced or recurrent disease, chemotherapy, hormone therapy (progestins) and immunotherapy are used; immunotherapy is especially effective in tumours with mismatch repair deficiency. Young women with an early, low-grade tumour who wish to become pregnant are sometimes offered hormone treatment that preserves the uterus under close monitoring; this is decided case by case.

The plan is drawn up by a multidisciplinary team of oncologists and gynaecological oncologists. The outlook depends on the stage and tumour type, so no result can be guaranteed.

Planning treatment in Israel

Send the clinic your reports, the pathology report and scans, and bring the biopsy slides and blocks with you. The work-up takes a few days; after minimally invasive surgery the hospital stay is usually one to three days, and the date of the flight home should be agreed with the surgeon. Ask for a written estimate listing what is included and check where further treatment and follow-up will take place. Other areas of women's health are covered under obstetrics and gynecology.

Frequently asked questions

Can a Pap test detect uterine cancer?

No. The Pap test is designed for the cervix; diagnosing endometrial cancer requires a biopsy.

Are the ovaries always removed?

Usually yes, but in young women with early-stage disease they can sometimes be preserved; this is discussed with the doctor.

Is chemotherapy needed after surgery?

Not for everyone. Additional treatment depends on the pathology results and the stage.

How often is follow-up needed after treatment?

Every three to six months for the first two to three years, then less often; the schedule is set by the doctor.

Need a second opinion or uterine cancer treatment abroad? Send a request and Clinics Direct medical coordinators will help you choose a clinic and find out the cost of tests and treatment free of charge.