Treatment of uterine cancer in Germany
Uterine cancer (endometrial cancer, endometrial carcinoma) is most common cancer of female reproductive organs in the developed countries.
This type of cancer is increasing from year to year, and this is due not only to the increase in the average age of people, but with a change of lifestyle.
The greatest rates of increase are in patients under the age of 29 years old. In the last 10 years, the incidence has increased by 50%.
Currently, the amount of uterine cancer in the world is an average of 15 cases per 100 thousand of female population per year. The risk of disease increases with age. Uterine cancer is most often diagnosed among older patients (65-70 years). The most frequent localization of the tumour is the body or the bottom of the uterine. Less often cancer develops in the lower uterine segment.
Causes of Uterine cancer
There are two basic pathogenic kinds of uterine cancer: hormone-dependent and autonomous.
The first type is experienced more often by 70% of patients, and has a more favourable prognosis with regards to survival.
Autonomous pathogenic type develops without the preceding ovulation disorders and it is characterized by an unfavourable prognosis.
Uterine cancer risk factors:
- Hormone preparations of estrogen therapy (without progesterone)
- Menopause after the age of 55
- Lack of regular sexual intercourse
- Infertility, absence of childbirth
- Absence of ovulation
- Liver cirrhosis and other diseases accompanied by increased levels of estrogen in the blood
- Hypertonic disease
Uterine cancer can develop against a background of other pathologies (e.g. hormone-producing ovarian tumours give rise to endometrial cancer with a 20% probability).
Uterine cancer - Symptoms
Uterine cancer is asymptomatic during the early stages. That’s why uterine cancer cannot be diagnosed during the early stages.
Among the early signs of uterine cancer are:
- Bleeding is most common for the postmenopausal period.
- Leucorrhoea is watery vaginal discharge, the occurrence of which is related to lymphorrhea (the leakage of the lymph).
- Pain in the pelvis. Localization of the pain is dependent on the size and the location of the tumour (lower back, lower abdomen). There may be both permanent and cramping pain.
Uterine cancer doesn’t have pathognomonic symptoms. These signs may indicate a number of other diseases that are not related to the cancer process.
Women can be observed and treated by a gynaecologist for hormonal disorders and cancer can be suspected only after the appearance of clear clinical symptoms or lesions of the bladder and bowel joining.
Uterine cancer - Diagnostics
Considering the asymptomatic course of the disease, diagnostic procedures and analysis that help to detect the cancer are of utmost importance. The earlier the tumour will be detected, the better the prognosis.
- Ultrasound is the best way of screening (mass) diagnostics method. Method is non-invasive and that’s the main advantage.
- Aspiration biopsy of the endometrium. With the help of the Brown syringe the tissues of the inner layer of the uterus for subsequent cytological examination is taken. In common forms of the disease cancer can be detected with a 90% chance probability. During the initial stages of the disease aspiration biopsy can detect abnormal cells with a only a 30% chance. But it can be done several times in a health centre, which increases the probability of a correct diagnosis.
- Fluorescent diagnostics is the latest research technique that identifies the tumour of a small size up to 1 mm in diameter. The sensitivity of fluorescence diagnostics is very high - up to 80%. However, it is not carried out in every clinic.
- Cervical Hysteroscopy takes a leading spot in uterine cancer diagnostics with the help of instrumental examination. Endoscopic diagnostics presupposes the instrument insertion into the uterine cavity. This procedure allows to not only evaluate the state of endometrium, but also to do the targeted biopsy.
- Fractional curettage (scraping). It may be carried out during the cervical hysteroscopy. It assumes separate obtaining of the biological material for research from different parts of the uterus. From time to time this diagnostic procedure is recommended for all women who are in the risk zone for cancer pathology of genitals.
- Histological examination. It confirms the diagnosis. Efficiency of this diagnostics method at the initial stage is 78%, for the common form of cancer of the uterus it is 100%.
- MRI. Magnetic resonance imaging is used to detect the metastatic pelvic lymph nodes.
Treatment of Uterine cancer abroad
The basis of the treatment is the surgery. Its volume is defined by the doctor on the basis of the examination results. The goals of treatment are the removal of the tumour, prevention of the metastases, and removal of the lymph nodes if necessary.
The following kinds of operations can be performed:
- Hysterectomy with appendages, pelvic lymphadenectomy (performed with a favourable prognosis of the disease)
- Extended hysterectomy with appendages (with poor prognosis)
Radiation therapy usually gives good results in uterine cancer treatment. Distant radiation of the pelvic is indicated if:
- Tumour penetrates the myometrium (muscle layer of the uterus) by a third
- The tumour is localized in upper-middle uterine segment
- Cancer has a medium or high average degree of differentiation
For the inoperable uterine combined radiotherapy is indicated (not only the remote exposure is applied, but also the introduction of radioactive intracavitary applicators is performed).
Such treatment is applied, if:
- Tumour has a low degree of differentiation, which worsens the prognosis
- Cancer is localized in the lower segment of the transition to the cervical canal
- There is a deep invasion into the myometrium
Patients are prescribed the hormonal therapy and correction of the metabolic processes after the surgery. The medications are chosen individually. The scheme of the medications treatment depends on the number of factors that are taken into the consideration by a doctor.
Uterine cancer - Prognosis
Prognosis depends on the stage and extent of the pathological process, histological forms of cancer (prognosis is better if the tumour is of high differentiation), pathogenic variants (better to treat hormone-dependent form of the disease than the autonomous cancer) and the quality of medical care.
The five-year survival rate of patients, depending on the stage is:
- I - 90% (in developed countries – up to 98%)
- II - 70%
- III - 32%
- IV - 5%
Recent medical achievements to the greatest extent help to extend the life of patients with cancer of the uterus while in the first and second stages, whereas treatment at stages 3 and 4 are not so successful.
The latest (innovative) treatment and diagnostics methods of Uterine cancer abroad
Photodynamic therapy (PDT) is one of the methods of uterine cancer treatment which is based on the possible influence of light waves of a certain length on abnormal cells. The essence of the procedure is in administering the special substances – photosensitizer – to the patient.
The latter can accumulate in the pathologically altered cancer cells. After absorption of the drugs into the organism a laser that can generate light at specific wavelengths is introduced. Due to the selectivity of the impact, the laser effectively impacts only the cancer cells with the photosensitizer inside.
When exposed to the light the triplet oxygen turns into the singlet in the structures with parallel release of large amounts of free radicals. This reaction leads to tumour necrosis and apoptosis at the molecular level.
The main advantage of PDT in the treatment of endometrial cancer is the organ conserving ability. Healthy cells that have no photosensitizers are not exposed to laser irradiation.
Immunotherapy. The essence of the method is in the ability to "teach" the body to deal with its own cancer cells. Under laboratory conditions it was possible to recreate the specific biological response modifiers (BRMS), which have the ability to stimulate and inhibit certain functions of the immune system.
The technique allows to:
- Inhibit the growth and development of atypical cells
- To assist the body's own immune structures to better "recognize" altered tissues
- Enhance the ability of healthy cells to regenerate
- Block the possibility of regeneration of normal structures into cancerous one
After the introduction of specific biological response modifiers, the body's own immune system starts to fight against the tumour.
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc