Uterine cancer

Endometrial Cancer

Endometrial (Uterine) Cancer

Endometrial cancer arises from the inner lining of the uterus and is the most common gynecologic cancer. It is often detected early and has an good prognosis in most cases.

Who Is at Higher Risk?

Risk factors include increasing age (most common after menopause), obesity, diabetes, hormonal imbalance (excess estrogen), and in up to 10%, genetic predisposition, especially Lynch syndrome

Detection and Diagnosis

Common symptom: abnormal uterine bleeding, especially after menopause.

Evaluation includes:

• Transvaginal ultrasound
• Endometrial biopsy (office procedure by pipelle, hysteroscopy, or dilatation and curettage)
• After diagnosis, imaging might help assess disease extent.

Types (Histology)

• Endometrioid (most common, usually less aggressive)
• Non-endometrioid (e.g., serous, clear cell, usually more aggressive)

Treatment

Early stage: Tumor confined to the uterus

• Surgery: (open/laparoscopy/robotic) hysterectomy with removal of ovaries and tubes and sentinel lymph node sampling
• In selected cases: fertility-sparing hormonal therapy (progesterone-based)

After surgery, sometimes adjuvant treatment is needed, depending on risk factors:

• radiation (to reduce local recurrence)
• and/or Chemotherapy
• and/or immunotherapy based on tumor profile

Advanced disease: Spread to abdomen or distant organs

• Chemotherapy (commonly carboplatin + paclitaxel) +/- immunotherapy
• Hormonal therapy (in selected tumors)
• Targeted therapy based on tumor profile

Personalized and Advanced Treatment in Endometrial Cancer

In Israel, molecular testing for endometrial cancer is included in the national health basket and helps guide personalized treatment by predicting prognosis, the need for additional therapy after surgery, and the risk of recurrence. Tumors with mismatch repair deficiency (MMRd) may be linked to Lynch syndrome, and genetic counseling is recommended for patients and sometimes family members.

For selected cases, advanced targeted therapies are available, such as antibody-drug conjugates (ADCs), including HER2-targeted treatments. These therapies deliver chemotherapy directly to cancer cells, offering a more personalized and effective option for patients with recurrent disease

Prognosis

Most patients are diagnosed early and have an excellent prognosis. Outcomes depend on stage, tumor type, and molecular features

We are here to guide and support you throughout diagnosis, treatment, and recovery. Please make an appointment via email at: [email protected]

Fertility-Sparing Treatment

For some women with early-stage, low-grade endometrial cancer who wish to preserve fertility, fertility-sparing treatment can be considered. This approach is based on the fact that many early tumors are hormone-sensitive, meaning they respond to estrogen and progesterone.

Who is eligible:

• Women with grade 1 (G1) endometrioid tumors
• Stage IA with no invasion into the muscle of the uterus on pelvic MRI

Treatment approach:

1. The uterus is first carefully evaluated and emptied using hysteroscopy or dilation and curettage (D&C) to remove tumor tissue and confirm diagnosis
2. Hormonal therapy is then started, often with a progesterone-releasing IUD (Mirena), sometimes combined with oral progesterone

Close monitoring is required with endometrial biopsies (Pipelle) every 2–3 months to check for response

Pregnancy planning:

• Once the tumor responds, trying to conceive is encouraged promptly, often with fertility treatments or IVF if needed
• Pregnancy is generally considered safe, as high progesterone levels help suppress tumor growth
• More than one pregnancy might be possible after treatment

Outcomes

• Worldwide literature reports a pregnancy rate of 30–70% and a live birth rate of 20–60% among carefully selected patients
• This approach allows women to achieve successful pregnancies while managing their cancer safely

We are here to guide and support you throughout diagnosis, treatment, and recovery. Please make an appointment via email at: [email protected]

Uterine sarcomas

Uterine sarcomas are rare and complex tumors that require highly specialized care. At Hadassah, our department has extensive experience in the surgical management of these malignancies, including complex resections and tailored procedures designed to achieve optimal oncologic outcomes while preserving function whenever possible. Each case is evaluated within a dedicated multidisciplinary team (MDT), bringing together gynecologic oncologists, radiologists, pathologists, radiation oncologists, and medical oncologists to formulate an individualized treatment plan. This collaborative approach ensures accurate diagnosis, appropriate staging, and integration of surgery with adjuvant therapies when indicated. Our expertise, combined with access to advanced technologies and clinical trials, allows us to provide patients with comprehensive, state-of-the-art care for uterine sarcomas.

We are here to guide and support you throughout diagnosis, treatment, and recovery. Please make an appointment via email at: [email protected]