Treatment of Endometrial Cancer (uterine Cancer) in Germany

Endometrial Cancer is one of the most common neoplasms of the reproductive system in women. Doctors in Germany successfully treat most cases of endometrial cancer. They use minimally invasive interventions for malignant tumor removal instead of traumatic interventions through a large incision in the anterior abdominal wall. German hospitals offer innovative options for radiation therapy. Healthcare professionals in Germany can treat even the advanced stages of endometrial cancer with good results by using modern drugs for targeted tumors and their metastases.

Content

1. Diagnostics
2. Surgical treatment
3. Radiation therapy
4. Drug therapy
5. How to undergo treatment in Germany

Diagnostics

There is no screening for endometrial cancer. In most cases, the disease is detected after the onset of symptoms.

Ultrasound scanning Ultrasound scanning is usually the first diagnostic procedure for women with the clinical signs of reproductive system diseases. Pelvic ultrasound is done with a transvaginal probe through the vagina. The doctor can see a tumor in the uterus.

Endometrial biopsy is a minimally invasive procedure to take a tissue sample, which is then examined in a laboratory. The biopsy can confirm the presence of the tumor and determine its type. The doctor inserts a thin tube into the uterus through the vagina and aspirates (suctions) the tissue.

Hysteroscopy is an endoscopic procedure for the uterus, using a small video camera to isolate the organ from the inside. Hysteroscopy allows the specialists to assess the organ's condition and conduct a targeted biopsy of a suspicious mass.

Dilation and curettage would be procedures for doubtful cases if the biopsy did not give the required result. For example, if the doctors have not managed to obtain high-quality tissue samples or if the biopsy results are ambiguous. The procedure is performed under anesthesia, as it involves cervical dilation and the removal of the functional layer of the mucous membrane. The resulting material is examined in the laboratory.

Instrumental diagnosis HELPS determine the stage of the disease, assess the size of the tumor, and the presence of metastases. Doctors in Germany use MRI, CT, PET scans, chest X-rays, cystoscopy, and ureter scope (endoscopic examination of the bladder and rectum). Most patients require not all but only some of these diagnostic tests.

Surgical treatment

Surgery is considered the main treatment for endometrial cancer. This is often the only treatment a woman needs.

A simple hysterectomy is a surgical procedure to remove the uterus. The extent of the surgical intervention may be quite different. Surgical approaches are also different. The doctor usually removes the uterus and the fallopian tubes, ovaries, and lymph nodes. In women under 45 years of age, the ovaries can be preserved to avoid premature menopause. But this surgery option is resorted to only if the doctor is sure that this will not worsen the oncological results. As a rule, the ovaries can be preserved at stage 1, but starting from stage two, they are removed regardless of age.

The healthcare professionals in Germany perform hysterectomies using laparoscopic techniques instead of a large abdominal incision. After such an operation, patients recover faster, lose less blood, and spend less time in the hospital. Some hospitals perform robot-assisted surgical interventions in the safest and most sparing. The operation is performed by a robotic surgical system, in which a gynecologist with remote control controls is at a distance from the operating field.

Doctors often perform surgery to remove the uterus through the vagina to treat benign uterine diseases. But in the case of cancer treatment, this approach is usually not used. The surgical procedures with a vaginal system can be used only in case of contraindications to the surgical intervention through abdominal incisions. Although vaginal surgery is sparing and safe, it can also be less effective, especially in the advanced stages of oncology.

Radical hysterectomy is the removal of more tissues. The surgical procedure is performed in cases where cancer has spread to the cervix or parametrium (tissues surrounding the uterus). The doctors remove not only the uterus with appendages but also ligaments, cellular tissue, and the upper part of the vagina. This surgical intervention is usually performed through the abdominal incisions, although in debilitated patients, a vaginal approach can accomplish it. The experienced German doctors even perform radical hysterectomy through short incisions using the laparoscopic technique.

Lymph node dissection is a stage of the operation involving lymph node removal. Since most procedures for endometrial cancer are performed through abdominal incisions, doctors do not need A different approach for lymph node dissection. But in rare cases, the uterus can be removed through the vagina. Such a patient still requires lymph node dissection. one cannot remove the lymph nodes through the vagina, so a different surgical approach is needed. Doctors in Germany perform laparoscopic lymph node removal. This variant of the surgical intervention is less traumatic and reduces the recovery period for the patient.

In some cases, when performing surgery, doctors conduct a pelvic lavage (obtain swabs to detect cancer cells), remove the omentum, or do a peritoneal biopsy. These manipulations allow establishing the exact stage of the disease, which is very important in oncology for planning the scope of postoperative treatment.

Sentinel lymph node biopsy is an innovative diagnostic procedure in oncology, which is performed during the uterine removal surgery. It has become widespread in countries with advanced medicine, including Germany. The sentinel lymph node biopsy is performed only at an early stage of uterine cancer. For many patients, this is an opportunity to avoid the lymph node dissection and the complications associated with it.

The essence of the procedure is that the doctor does not remove all regional lymph nodes but only those that are the first to collect lymph from the tumor. If they are e not affected by metastases, the specialists can conclude that they are also absent in the other lymph nodes. A Dye and a radionuclide are injected into the tumor site to identify the lymph nodes. The dye is then found visually, while the radioactive substance is detected with a gamma camera. The lymph nodes identified as the sentinel ones are removed and examined. The lymph node dissection will not be performed should they have no cancer cells. Should they be found, they will also remove other regional lymph nodes. This is required to reduce the risk of cancer recurrence and determine the exact stage of the disease.

Radiation therapy

In the oncology departments at German hospitals, doctors use two types of radiation therapy for uterine cancer treatment:

• external beam radiation therapy;
• brachytherapy. 

These two methods can also be combined. If both of them are used in the same patient, then external beam radiation therapy comes first and brachytherapy becomes the second option.

External beam radiation therapyis the most common option used in oncology. Radiation Therapy is often carried out after surgery to kill any remaining cancer cells. Radiation therapy is started 4-6 weeks after surgery to restore tissues fully. The cases when external beam radiation therapy is used before surgery (to reduce the size of the tumor) or as an independent method of cancer treatment if surgery is contraindicated for a woman are not very common. Radiation therapy is carried out five (5) days a week for 4-6 weeks. Each procedure takes about half an hour. Chemotherapy can be additionally used to enhance a therapeutic effect.

Brachytherapy is a variant of contact irradiation of the tissues. A cylinder is placed in the vagina, and radioactive materials are injected into it. As a rule, this type of treatment is used for endometrial cancer recurrence from the vaginal stump. The key advantage of this method compared to external beam radiation therapy is that the radiation does not pass through the healthy tissue on its way to the tumor. This results in a significantly reduced radiation exposure to the bladder and rectum, which lowers the risk of complications.

There are two types of brachytherapy used in oncology: 

• low-dose rate – prolonged exposure to low doses of radiation;
• high-dose rate – uses strong, but short-lived radiation. 

Low-dose rate brachytherapy is rarely used in Germany. It requires bed rest for several days, reducing treatment tolerability and threatens complications, such as deep vein thrombosis of the lower extremities. Therefore, German experts prefer high-dose-rate brachytherapy. They carry out three procedures for 10-20 minutes, which allow destroying the recurrent tumor. The patient does not require any hospitalization: she can visit the hospital once a week. It is possible to reduce the intervals between irradiation sessions, which is very convenient for foreign patients who do not want to stay abroad for a long time.

Although brachytherapy is generally safer than external beam radiation therapy, it often causes vaginal side effects such as dryness, redness, and discomfort. Over time, the vagina can narrow, which affects the quality of sexual life. The use of special expanders can solve this problem.

Drug therapy

Chemotherapy is the primary method of drug treatment. Doctors use drugs that affect cancer cells throughout the whole body, not only in the uterus. Chemotherapy is usually used for:

• inoperable tumors at the advanced stage of cancer;
• high-grade cancer, along with radiation therapy to avoid recurrence after surgery;
• recurrent tumor suppression unless brachytherapy or surgery is used.

Even with aggressive tumors, chemotherapy is used only from stage 3. As a rule, a combination of drugs is used. Chemotherapy with a single drug is provided only for debilitated patients who cannot tolerate polychemotherapy.

Chemotherapy is often combined with radiation therapy. These two methods are used simultaneously, and this approach is called chemoradiotherapy. Sandwich therapy can also be used for the treatment of endometrial cancer. This therapy involves the use of chemotherapy first, then radiation therapy, and then doctors return back to chemotherapy. This scheme can be applied for uterine papillary serous carcinoma and uterine carcinosarcoma.

Hormone therapy involves the prescription of drugs that block female sex hormones and actually cause artificial menopause. The method is combined with chemotherapy and is used according to the same indications. Hormone therapy for the treatment of endometrial cancer in German hospitals uses progestins, luteinizing hormone-releasing hormone agonists, aromatase inhibitors or antiestrogen. Medicines differ in ease of use, but their effectiveness is comparable. The principle of action is based on the fact that hormones stimulate the growth of a malignant tumor, but if the hormone levels become lower, then the cancer progresses more slowly.

Targeted therapy uses drugs that target cancer cells by interacting with specific molecular targets. They are generally better tolerated than chemotherapy and still provide good results. In the case of endometrial cancer, German doctors use kinase inhibitors, angiogenesis inhibitors, or inhibitors. Targeted therapy can be combined with chemotherapy and hormone therapy. It is usually used at the advanced stages when cancer recurs and other treatment options have not been effective enough.

Immunotherapy aims to stimulate the immune response against cancer cells. For the treatment of endometrial cancer, PD-1 inhibitors are used. An additional diagnosis is required to understand if you are a suitable candidate for this treatment option. Immunotherapy is conducted in case of microsatellite instability (MSI-H), a defect in the mismatch repair gene (dMMR) or a high tumor mutation burden (TMB-H). Immunotherapy is used when other treatment options do not work.

How to undergo treatment in Germany

If you are going to have the treatment of uterine cancer in Germany, the Booking Health service will be helpful. With our website, you can get up-to-date and accurate information about the cost of Treatment in Germany. In Germany, compare prices in different hospitals and book a medical care program at the best price. The Treatment in Germany. It will be easier and faster for you, and the cost of Treatment in Germany will be lower.

Please leave your request on the website of the medical tourism facilitator Booking Health. Our employee will contact you, provide advice and answer all your questions. We will take care of the organization of your trip for cancer treatment in Germany. We will provide the following benefits for you:

• We will select a hospital and an oncology department in the German hospital whose doctors specialize in the diagnosis and treatment of endometrial cancer.
• We will help to overcome the language barrier and establish communication with the doctor of the German hospital.
• The waiting period for the treatment in Germany will be reduced for you, and you will receive medical care on the most suitable dates.
• We will reduce the price. The cost of treatment in Germany will be lower than usual. Eliminating overpricing and additional coefficients for the foreign patient will reduce it.
• Our specialists will solve any organizational issues: paperwork, transfer from the airport to the hospital and back, hotel booking, interpreting services.
• We will prepare your documents and translate them into English or German. You do not have to repeat the previously performed diagnostic procedures.
• We will keep in touch with the German hospital after the completion of your treatment in Germany.
• We will organize additional Treatment in Germany, diagnosis, or rehabilitation if required.
• We will buy medicines in Germany and forward them to your native country.

While the best specialists in the world are taking care of your health, the Booking Health staff will help to reduce the cost of treatment in Germany and take care of all the travel arrangements.

Authors:

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

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Sources:

National Cancer Institute

Cancer Support Community

Cancer. Net