Factors that increase the risk of endometrial cancer include:

• Age: Older people are at higher risk of developing this type of cancer. Endometrial cancer occurs most often after menopause.
• Obesity: Being obese increases your risk of endometrial cancer. This may happen because extra body fat can alter your body's balance of hormones.
• Early menstruation or late menopause: People who start menstruation before age 12, or go into menopause later in life than usual, are more likely to develop endometrial cancer. 

• Hormonal changes: Changes in the balance of the two main female hormones (estrogen and progesterone) can affect the endometrium, making cancer more likely to develop. Conditions that affect ovulation, such as polycystic ovary syndrome (PCOS), obesity and diabetes, can also change hormone levels and heighten a person’s risk. 
• Hormone therapy for breast cancer: Taking hormone therapy (tamoxifen) for breast cancer can increase the risk of endometrial cancer.
• Hormone replacement therapy that contains only estrogen after menopause.
• Earlier radiation therapy to your pelvis: Radiation therapy to the pelvis to treat other cancers can damage cell DNA. This damage may increase your risk of developing a second type of cancer.

If you develop any of the symptoms listed above, such as post-menopausal bleeding or abnormal vaginal discharge, a gynecologist may use one or more of these tests to establish the diagnosis:

• Pelvic exams: Your doctor examines the inside of the vagina and the cervix and looks for abnormalities. The doctor also feels the size and shape of the uterus and ovaries, which can help identify a problem.
• Transvaginal ultrasound. This test uses sound waves to produce an image of the tissues of the uterus and pelvic area. In this procedure, an ultrasound probe will be inserted in the vagina.
• Pap smear: A Pap smear is not a screening for endometrial cancer, but it sometimes can show signs of an abnormal endometrium. A Pap smear is a sample of cells collected from the cervix to detect cervical cancer.
• Endometrial biopsy. In this procedure, a doctor removes a small piece of tissue from the endometrium. A pathologist then examines the tissue under a microscope to check for the presence of cancer cells.
• Dilation and curettage (D&C). Also known as uterine scraping, in this procedure, a doctor inserts a curette (an instrument with a spoon- or hoop-shaped end) into the vagina and uterus and uses it to scrape part of the endometrium. In a lab, a pathologist examines the tissue sample to see if cancer cells are present.
• Hysteroscopy. This procedure allows a doctor to visually examine the endometrium. A doctor inserts a thin tube called a hysteroscope into the vagina and uterus. If the doctor detects abnormal tissue, they can also biopsy a small piece of tissue through the hysteroscope.

If uterine cancer is diagnosed, your doctor will order additional tests to learn more about the type of cancer involved and to determine whether the cancer has spread beyond the uterus. This is known as staging, and may involve imaging studies such as:

• Computed Tomography (CT scans).
• Magnetic resonance imaging (MRI): Some doctors also think MRI is a good way to tell whether, and how far, the endometrial cancer has grown into the body of the uterus. MRI scans may also help find enlarged lymph nodes.
• Positron emission tomography (PET): This test can be helpful for spotting small collections of cancer cells. PET scans are not a routine part of the work-up of early endometrial cancer, but may be used for more advanced cases.

Your health care team uses information from these tests and procedures to assign your cancer stage. Staging helps doctors make a prognosis and put together a personalized treatment plan.

Doctors develop a plan to treat endometrial cancer based on several factors, including your :

• Cancer type and stage
• Imaging studies
• Medical history
• Overall health
• Preferences and decisions

Most people with endometrial cancer need surgery. Other treatments you may have include:

• Chemotherapy, which uses powerful drugs to destroy cancer cells.
• Radiation therapy, which sends targeted radiation beams to destroy cancer cells.
• Hormone therapy, which gives hormones or blocks them to treat cancer.
• Immunotherapy, which helps your immune system fight cancer.
• Targeted therapy, which uses medications to target specific cancer cells to stop them from multiplying.

Surgery:

Surgery is the most common first step in treating endometrial cancer. Your oncologist may recommend surgery to remove cancer cells or to determine the stage of the cancer and potential need for additional treatment, such as chemotherapy and/or radiation after surgery.

 You’ll most likely have a hysterectomy, with the surgeon removing your uterus and cervix. There are four types of hysterectomy procedures:

• Total abdominal hysterectomy: The surgeon makes an incision (cut) in your abdomen to access and remove your uterus.
• Vaginal hysterectomy: The surgeon removes your uterus through your vagina.
• Radical hysterectomy: If cancer has spread to your cervix, you may need a radical hysterectomy. The surgeon removes your uterus and the tissues next to your uterus. The surgeon also removes the top part of your vagina, next to your cervix.
• Laparoscopic hysterectomy: The surgeon makes multiple small incisions (cuts) to remove your uterus. 

During a hysterectomy, surgeons often perform two other procedures, as well:

• Bilateral salpingo-oophorectomy (BSO) to remove your ovaries and fallopian tubes. Most people need this extra step to make sure all cancer gets removed.
• Lymph node dissection (lymphadenectomy) to remove lymph nodes and see if cancer has spread.Lymph node assessment, performed during surgery, which can be done several ways:
  • Preoperative and intraoperative assessment to determine if complete removal of pelvic and para-aortic lymph nodes is necessary
  • Complete pelvic and para-aortic lymph node dissection
  • Sentinel lymph node mapping and biopsy. During this procedure, performed at the time of a hysterectomy, a fluorescent dye is injected into the cervix to map the lymph node channels from the uterus. A special camera helps the surgeon remove the first draining lymph nodes from the site of the primary tumor and determine if cancer has spread to the lymph nodes. Sentinel lymph node mapping allows the surgeon to determine if the cancer has spread to the lymph nodes without removing all lymph nodes.

During surgery, your surgeon also will inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon also may remove lymph nodes for testing. This helps determine your cancer's stage.

Radiation therapy:

Radiation therapy uses high-energy radiation (like x-rays) to kill cancer cells. It can be given in 2 ways to treat endometrial cancer:

• By putting radioactive materials inside the body. This is called internal radiation therapy or brachytherapy.

In brachytherapy, a doctor inserts a small, radiation-containing cylinder into the vagina, close to the uterus. While the cylinder remains in place (for ten or twenty minutes to several days), it emits radiation that destroys cancer cells. Multiple doses of brachytherapy may be necessary.

• By using a machine that focuses beams of radiation at the tumor, much like having an x-ray. This is called external beam radiation therapy.

In some cases, both brachytherapy and external beam radiation therapy are used. When that's done, the external beam radiation is usually given first, followed by the brachytherapy. The stage and grade of the cancer are used to help decide what areas need to be treated with radiation therapy and which types of radiation are used.

Radiation is most often used after surgery to treat endometrial cancer. It can kill any cancer cells that may still be in the treated area. If your treatment plan includes radiation after surgery, you will be given time to heal before starting radiation.

Less often, radiation might be given before surgery to help shrink a tumor so it's easier to remove.

Women who are not healthy enough for surgery may get radiation as their main treatment.

Chemotherapy:

In chemotherapy, drugs are used to destroy or damage cancer cells. These drugs may be administered by mouth or injection.

These drugs go into the bloodstream and reach throughout the body. Because of this, chemo is often part of the treatment when endometrial cancer has spread beyond the endometrium to other parts of the body and surgery can't be done.

In most cases, a combination of chemo drugs is used. Combination chemotherapy tends to work better than one drug alone.

Chemo is often given in cycles: a period of treatment, followed by a rest period. The chemo drugs may be given on one or more days in each cycle.

Chemotherapy is sometimes used after surgery to lower the risk that the cancer might return. Chemotherapy also can be used before surgery to shrink the cancer. This makes it more likely that the cancer is removed completely during surgery.

Chemotherapy may be recommended for treating advanced endometrial cancer that has spread beyond the uterus or to treat cancer that has come back.

Hormone therapy:

Hormone therapy involves taking medicines to lower the hormone levels in the body. In response, cancer cells that rely on hormones to help them grow might die. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.

Targeted therapy:

Targeted therapy uses medicines that attack specific proteins or other components of cancer cells that are not found in noncancerous cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is usually combined with chemotherapy for treating advanced endometrial cancer.

Immunotherapy:

Immunotherapy uses medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments haven't helped.

Palliative care:

Palliative care is a special type of health care that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. Palliative care is done by a team of health care professionals. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Endometrial cancer care at Shefa-Elorman:

Shefa-Elorman doctors offer compassionate, comprehensive care for those with endometrial cancer.

At Shefa-Elorman Hospital, gynecologic oncologists, radiation oncologists, medical oncologists and surgeons work as a multidisciplinary team to care for people with endometrial cancer. Other professionals are included as needed.

Shefa-Elorman doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals. Doctors have access for a full range of treatments for endometrial cancer, including standard treatments and the latest developments in cancer treatments.

Options might include:

• Minimally invasive surgery.
• Sentinel lymph node biopsy.
• Fertility-sparing treatments that preserve your ability to become pregnant.
• Radiation therapy.
• Brachytherapy.
• Chemotherapy.
• Biological therapy for cancer, including immunotherapy.

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination and examination under anesthesia.
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical blood test
  • inflammation markers (CRP, ESR)
  • blood coagulation analysis (aPTT, PT, INR)
  • tumor markers (CEA, CA19-9, CA125)
• gynecological examination:
  • colposcopy
  • vaginal swab
  • cervical or uterine biopsy with histological analysis (if clinically indicated)
  • pelvic and abdominal ultrasound
  • transvaginal ultrasound
• CT/MRI of the abdomen and pelvic organs (if clinically indicated)
• nursing services
• consultation of related specialists
• treatment by chief physician and all leading experts
• explanation of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Previous Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

_________________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically)  
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators of blood coagulation
  • tumor markers (CEA, CA19-9, CA125)
• CT and MRI planning of radiation therapy
• Physics calculation  
• full course of conventional radiation therapy (3D, IMRT, or VMAT )or brachytherapy separate or together (sequential) depending on your cancer stage and your treatment options will be explained by treating physician  
• anesthesia assessment in a case of brachytherapy 
• chemotherapy weekly with radiotherapy, the cost of medicines is included  
• symptomatic treatment
• cost of essential medicines and materials including masks and mattress used for fixation.
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

During the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

The use of brachytherapy with types of implants may be called , wires, needles, capsules, balloons, or tubes. No matter which type of implant is used, it is placed in your body (transvaginal) , very close to or inside the tumor. This way the radiation harms as few normal cells as possible. The implant procedure is usually done in a hospital operating room designed to keep the radiation inside the room. You’ll get anesthesia, which may be either general (where drugs are used to put you into a deep sleep so that you don’t feel pain) or local (where part of your body is numbed). Imaging tests (an x-ray, ultrasound, MRI, or CT scan) are usually used during the procedure to find the exact place the implant needs to go. High-dose-rate (HDR) brachytherapy allows a person to be treated for several minutes at a time with a powerful radioactive source that’s put in the applicator. The source is removed after 10 to 20 minutes. This may be repeated twice a day over a few days, or once a day over the course of a few weeks. The radioactive material is not left in your body. The applicator might be left in place between treatments, or it might be put in before each treatment. If your implant is held in place by an applicator, you may have some discomfort in that area. 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

______________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor markers (CEA, CA19-9, CA125)

• colposcopy
• vaginal swab
• cervical biopsy with histological analysis (if clinically indicated, additional cost is 2000 €)
• pelvic and abdominal ultrasound
• transvaginal ultrasound
• CT/MRI of the abdomen and pelvic organs (if clinically indicated)
• preoperative care
• operation: 

• hysterectomy with extensive surgical resection
• hysterectomy adnexectomy and lymphadenectomy

• histologically and immunohistochemically examination of the excised tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 8-10 days

___________________________________________________________________________

4- chemotherapy or immunotherapy: 

The program includes:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • biochemical analysis of blood
  • tumor markers
  • inflammation indicators
  • indicators of blood coagulation
• ultrasound scan, CT / MRI scan (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• Colonoscopy data, MRI/CT scan (not older than 3 months)
• Biopsy results 
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: outpatient 

Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)