Uterine Cancer Treatment in Israel
Head of the Gynecologic Surgery Department
Head of the Gynecologic Surgery Department
The cancer diagnosis is not confirmed in 38% of women coming to Ichilov from Eastern Europe for uterine cancer treatment.
The examination for uterine cancer in Ichilov takes 3-4 days and costs $2,960.
Surgery: robotic hysterectomy using the Da Vinci Xi surgical robot, laparoscopic hysterectomy, sentinel node biopsy, organ-preserving surgery with preservation of the ovaries.
Radiation therapy: intensity modulated radiation therapy (IMRT), MRI-controlled radiation therapy, brachytherapy with the HDR-Bravos machine.
Targeted therapy: mTOR inhibitors (everolimus, temsirolimus, ridaforolimus), angiogenesis inhibitors (bevacizumab, trastuzumab). The dostarlimab drug and the lenvatinib+pembrolizumab protocol implemented in 2021.
Immunotherapy: pembrolizumab (Keytruda). Metformin therapy (also for women planning to become pregnant).
In Top Ichilov, uterine cancer treatment is provided by a multidisciplinary team that includes:
- Gynecologic oncologist, Professor D. Grisaru;
- Oncologist, Professor M. Inbar;
- Nuclear medicine specialist, Professor E. Even-Sapir.
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UTERINE CANCER DIAGNOSIS IN ISRAEL
If uterine cancer is suspected, an Israeli doctor may order MRI, CT, ultrasound, biopsy or hysteroscopy. If the initial ultrasound confirms the diagnosis, the doctor may order an MRI scan or a biopsy to study the tumor in more detail. A biopsy is a 100% accurate way to confirm the presence and stage of the tumor.
Detailed information on the diagnostic procedures in Top Ichilov:
- Transvaginal ultrasound. This procedure is one of the main methods of primary uterine cancer diagnosis. It helps assess the thickness of endometrium and detect uterine tumors. It is combined with endometrial biopsy for higher precision. Price for the procedure: $225.
- Pelvic MRI scan. Helps assess the state of the lymph nodes and find out if the cancer has spread to the cervix. Price for the procedure: $905.
- Computed tomography. CT is used in preoperative tumor imaging. Price for the procedure: $236.
- Hysteroscopy with endometrial biopsy. Helps differentiate benign and malignant tumors. Price for the procedure: $481.
EXAMINATION PROGRAM FOR UTERINE CANCER IN TOP ICHILOV
Day 1: Initial Consultation
The patient sees Dr. I. Molchanova, Head of Cancer Diagnosis Department. The doctor offers a primary physical exam, compiles health history (in Hebrew), and refers the patient for laboratory and instrumental examinations. If the patient brought slides and/or paraffin blocks for revision, they are sent to the laboratory of the clinic.*
*For revision, it is necessary to bring the medical document identifying the patient’s slides/blocks.
Day 2: Diagnostic Procedures
The patient accompanied by a medical coordinator-interpreter, undergoes recommended testing and instrumental examinations:
- Comprehensive clinical and biochemical blood tests.
- Analysis of urine.
- Tumor marker CA 125 blood test. A high level of CA 125 may indicate that the cancer has spread beyond the uterus or recurred.
- PET-CT (positron emission tomography).*
*PET-CT is not used: – earlier than 2-2.5 weeks after chemotherapy; – earlier than 5-6 weeks after radiation therapy; – earlier than 5-6 weeks after surgery.
Day 3: Treatment Planning
The patient sees one of the experts to receive a treatment plan. She may consult with:
- Oncologist: depending on the tumor type, the patient visits Prof. M. Inbar or Prof. O. Merimsky;
- Gynecologic oncologist, surgeon – Prof. D. Grisaru;
- Radiation therapist – Doctor D. Matseevski.
The plan is executed within 3-4 working days. Price: $2,960.
✓ Right now: An opportunity to consult with a Top Ichilov doctor for free
It is important to correctly identify the type of the disease before starting treatment in your region. Get a free consultation with an Israeli doctor right now. Find out the cost of the required diagnostic procedures in Top Ichilov.
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ADVANTAGES OF UTERINE CANCER TREATMENT IN TOP ICHILOV
- Use of PET-CT to determine the exact stage of the disease. This study helps detect metastases even when they are only 3-5mm in size.
- Possible pregnancy in uterine cancer patients. If the woman has no children, in some cases Israeli specialists postpone the removal of the uterus until the woman becomes pregnant and the baby is born. During this whole time, hormone therapy is used.
PHYSICIANS WHO TREAT UTERINE CANCER IN TOP ICHILOV
Treatment and examination of uterine cancer patients in Top Ichilov is provided by the leading Israeli oncologists:
Professor Dan Grisaru, Head of the Gynecologic Oncology Department. Professional experience: over 35 years. Was included into the list of the best Israeli physicians in 2019 according to the “Forbes” magazine.
Professor Moshe Inbar, Head of the Department, the most experienced Israeli medical oncologist. Was Head of Israel Cancer Association and Israel Breast Cancer Group for many years. Cooperated with internationally renowned American cancer centers. Author of about 200 scientific publications.
Doctor Irina Stefanski, oncologist, Head of Chemotherapy Department, Deputy Head of Oncology Department. Professional experience in oncology: about 27 years. Is considered one of the leading specialists in complex cancer therapy.
Professor Diana Matseevski, leading radiologist of the Ichilov Hospital. Specializes in treating cancer with radiation therapy. Treats gynecologic cancers and malignant tumors of the uterus. Uses advanced methods of external radiation therapy.
Professor Einat Even-Sapir, the best Israeli expert in nuclear medicine. Interprets PET-CT scans that are used all over Israel for uterine cancer staging and detection of metastases.
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SURGICAL TREATMENT FOR UTERINE CANCER IN ISRAEL
Removal of the uterus (hysterectomy) is the main method of uterine cancer treatment: surgery is used in 90% of women with the disease. In Top Ichilov, these surgical procedures are performed by the famous gynecologic oncologists from the large Ichilov State Hospital: Professor Dan Grisaru and Professor Joseph Lessing.
During surgery, the doctors remove:
- Fallopian tubes;
Lymph nodes may also be removed for histological analysis.
Before surgery, the patient’s abdomen is filled with gas (carbon dioxide). It facilitates the surgeon’s work. Then, four punctures are made: one near the navel and three in the lower abdomen. The doctor inserts surgical tools, a light and a small video camera through the openings. He or she sees the magnified surgical site on the screen. 1-2 days after laparoscopic surgery, the woman is discharged from hospital. In about 1.5 months, she will be able to resume sexual activity.
If there are no metastases, additional treatment is usually not required. A study with 1,682 participants showed that laparoscopic removal of the uterus was safer than open surgical intervention. While open surgery caused complications in 21% of patients, laparoscopic surgery was associated with complications only in 14% of cases. After open surgery, 94% of women had to stay in the hospital for over 2 days, while only 52% of women stayed that long after the laparoscopic procedure.
Laparotomy (Open Surgery)
In Israel, this type of surgery is commonly used in the more advanced stages of uterine cancer. This includes debulking surgery, or removal of all visible tumor tissues.
Laparoscopic procedures are commonly carried out with the help of a robot. During robotic surgery, the surgeon sits at the control panel set up in the operating room. The doctor manipulates surgical tools and operates through small incisions by moving the robotic arms.
Lymph Node Removal (Lymphadenectomy)
To determine the stage of cancer, the surgeon also removes the lymph nodes located in the pelvic area and around the aorta. This procedure is carried out during the hysterectomy. Lymph nodes are removed through the same incision that is made for abdominal hysterectomy (laparotomy). If the procedure is performed through the vagina, lymph nodes may be removed with the help of a laparoscope. Aside from standard lymphadenectomy, sentinel lymph node biopsy is also successfully used in Israel to determine the stage of uterine cancer. The high diagnostic accuracy of this method was proved by the study with 385 participants conducted in 2015.
If endometrial cancer has spread to the cervix or nearby tissues (the so-called parametrium), doctors recommend radical hysterectomy. During this procedure, the surgeon completely removes the uterus, nearby tissues (parametrium and uterosacral ligaments) and the upper part of the vagina close to the cervix. The doctor also removes the ovaries and the fallopian tubes. The procedure is usually carried out through an abdominal incision but it may also be done through the vagina. Research shows that the drawbacks of this surgery include a longer stay in the hospital (up to 10 days).
Historically, removal of the uterus – radical hysterectomy – also involved removal of multiple pelvic lymph nodes. This caused serious complications. Now, a sentinel node biopsy is done before hysterectomy. Fluorescent material is administered through the cervix to identify the first lymph node that drains the tumor area (the so-called sentinel lymph node). This lymph node is removed and sent for analysis. If it contains no cancer cells, there is no need to remove the remaining lymph nodes. Both sentinel node biopsy and hysterectomy may be done as laparoscopic procedures, including use of the Da Vinci surgical robot. The robot improves the precision of surgery.
After abdominal hysterectomy, patients stay in the hospital for 3-7 days. The average duration of inpatient treatment after abdominal radical hysterectomy is 5-7 days. Complete rehabilitation takes about 4-6 weeks.
The laparoscopic procedure and vaginal hysterectomy involve 1-2 days of inpatient treatment and 2-3 weeks of post-operative rehabilitation. Radical hysterectomy affects the nerves that control bladder function. This is why an urinary catheter is used for a few days after the surgery.
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RADIOTHERAPY FOR UTERINE CANCER
Radiation therapy in Israel is commonly used for metastatic cancer. It is also used if the risk of recurrence is high. In some cases, when the woman’s condition makes surgery impossible, radiation therapy becomes an alternative to surgical treatment in Israel.
External Radiation Therapy
The duration of radiotherapy for uterine cancer depends on the stage, size, and spread of cancer. As a rule, the course of treatment lasts for a few weeks. Before therapy, the specialist makes small marks on the patient’s skin so that radiation can be delivered directly to the tumor. The procedure is absolutely painless.
Internal Radiation Therapy (Brachytherapy)
Radiation is delivered with a special device inserted into the uterus. It is an outpatient procedure that requires anesthesia. Brachytherapy for uterine cancer may involve low-energy or high-energy radiation. If low-energy radiation is used, the applicator is left in the uterus for a few hours. Otherwise, it only remains in the uterus for a few minutes.
A study of 427 patients with stage 1-2 uterine carcinoma showed that brachytherapy is less toxic to the digestive tract in comparison with external radiation therapy to the pelvis. At that, both radiotherapy methods proved to be equally effective.
CHEMOTHERAPY FOR UTERINE CANCER
Chemotherapy may be used for uterine cancer if the disease recurred or spread to other organs and tissues and does not respond to hormone therapy. In Top Ichilov, chemotherapy protocols are developed by the internationally renowned oncologist, Professor Moshe Inbar.
What to Expect from Uterine Cancer Chemotherapy in Israel?
Chemotherapy drugs are usually administered through an IV line at the regular or day hospital. Chemotherapy departments in the Israeli clinics provide patients with utmost comfort. The atmosphere created by the medical personnel does not remind of hospitals. Still, administration of drugs is strictly controlled and checked hourly. To control the effectiveness of treatment, specialists may carry out diagnostic procedures.
Most often, uterine cancer requires adjuvant chemotherapy. This is chemotherapy prescribed after the surgical removal of the uterus (hysterectomy). In this case, chemotherapy aims to destroy remaining micrometastases. When chemotherapy is combined with radiation, it helps reduce radiation exposure, i.e. the number of treatments.
Chemotherapy is delivered in cycles. Each cycle lasts for 7-14 days. Every treatment period is followed by a period of rest so the patient’s body could recover. The duration of uterine cancer treatment depends on the patient’s condition, age, response to chemotherapy drugs, stage of the disease, etc.
|Adjuvant (used after surgery to destroy micrometastases)||Combination of paclitaxel (or docetaxel), doxorubicin and cisplatin (or carboplatin)|
|Palliative or used for recurrent tumors||Capecitabine and gemcitabine|
Hormone Therapy for Early-Stage Uterine Tumors
If the tumor has been detected in its early stage, in some cases women are offered hormone treatment in Israel that allows to become pregnant and have a baby before hysterectomy. Hormone therapy involves treatment with Megace (megestrol acetate), a synthetic progestin. Research shows that in 46-80% of patients signs of the disease disappear within 3 months after starting therapy.
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TREATMENT METHODS IMPLEMENTED IN 2021
Combined Targeted Therapy: Lenvatinib (Lenvima) and Pembrolizumab (Keytruda)
This protocol is used for inoperable metastatic uterine body cancer without high-frequency microsatellite instability. Clinical trials showed that the new treatment regime helped patients achieve longer remission.
This PD-1 inhibitor showed great results in the treatment of recurrent or metastatic uterine cancer in clinical trials. After treatment, the tumor size was reduced at least by 50% in 85% of patients.
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How to Receive Uterine Cancer Treatment in Top Ichilov
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