cervical cancer
Information on cervical cancer
Definition: What is cervical cancer (cervical carcinoma)?
Cervical cancer, also known as cervical carcinoma, is a degeneration of the cells of the cervix. Depending on the origin of the tumor in the cervix, a distinction is made between squamous cell carcinoma and adenocarcinoma.
Cervix with tumorIn squamous cell carcinoma, the cervical tumor develops in the upper mucous membrane cell layers and is the most common cancerous tumor in the cervix at 70%-80%. Adenocarcinoma is much rarer at 10%-20% and originates from the glandular tissue of the cervix.
The change in cells from normal cervical cells to cancer cells takes place over several years. The cancer cells are preceded by precancerous lesions, which can be easily detected by a smear test as part of the annual cancer screening at the gynecologist.
As a precancerous lesion or in the early stages, cervical cancer is almost always curable. That is why it is very important to attend your annual cancer screening appointments with your gynecologist from the age of 20.
Cervical cancer or uterine cancer? What is the difference?
The uterus consists of the uterine body and the cervix. Cancer of the cervix is much more common than cancer of the uterine body. Medicine also distinguishes between the following uterine tumors due to the different courses and treatment:
Cervical cancer
- Uterine body cancer (endometrial carcinoma)
- Cancer of the uterine muscles (soft tissue sarcomas)
- Causes and risk factors of cervical cancer
- Over the years, various risk factors for the development of cervical cancer have been identified. The common factor here is basically sexual intercourse. The risk increases with early and frequent sexual intercourse, as well as the number of sexual partners.
Cervical cancer is significantly less common, particularly in population groups with good genital hygiene and/or with circumcised men (germs feel particularly comfortable under the foreskin, in the moist, warm environment).
In this context, the human papillomavirus (HPV) was also examined more closely. It turned out that the sexually transmitted virus often leads to a malignant transformation of the cells of the cervix. Certain types of virus can even remain in the vaginal area for years. But viral infections with the herpes simplex virus or HIV, as well as increased nicotine consumption, also increase the risk.
Cervical cancer symptoms
Only about 5% of infections lead to precursors or malignant cervical cancer via cell changes. The disease usually remains completely asymptomatic. Occasionally it can lead to light spotting or, in later stages, contact bleeding during sexual intercourse or sweet-smelling discharge.
In advanced stages, the tumor can then constrict organs in the pelvis and thus lead to various types of bladder and bowel disorders with pain of varying intensity and duration. Pregnancy has no influence on the development of cancer.
Diagnosis and stages of cervical cancer
As part of cancer prevention, a gynecologist takes a Pap smear of the cervix once a year from the age of 20. The cells obtained with the cotton swab are examined under the microscope for cell changes. The Pap result is divided into the following stages and determines the further course of action:
Pap I: Findings are unremarkable
Pap II: Individual cells are changed, but there is no reason to worry!
Pap III: Further assessment and clarification is necessary
Pap IV: Precancerous stage (dysplasia) or early stage cancer is very likely
Pap V: Cancer is very likely
Further diagnostics for Pap III
If Pap test results in Pap III do not indicate that cancer is present. However, checks should be carried out at regular intervals. An HPV test can also be carried out. Cell changes can still regress on their own with Pap III without further treatment being necessary. The treating gynecologist will discuss the appropriate further procedure with his patient.
Further diagnostics for Pap IV and V
If a Pap IV or Pap V result is found, you should not wait any longer, but start further diagnostics immediately. To assess the cell changes in the cervix, a vaginal endoscopy is carried out, known as colposcopy. The treating gynecologist first examines the cervix in detail using light, stains suspicious areas with vinegar or iodine and takes a tissue sample. For the patient, colposcopy is hardly any different from a normal gynecological examination and is usually painless. Taking the tissue sample also causes no pain for most patients.
The sample is sent to a laboratory for histological analysis. It can take a few days for the results to reach the gynecologist again. If cell changes can be confirmed by the tissue sample, the patient is divided into stage groups depending on the degree and extent of the cell changes.
The following stages can be roughly distinguished:
- Precancerous stage
- Early stage cervical cancer
- Invasive carcinoma (cervical cancer)
Further diagnostics for cervical cancer
What further diagnostic measures are taken after examining the tissue sample depends largely on the individual case. In preparation for therapy, all the necessary data on the tumor can be collected with the help of X-rays and ultrasound examinations, and in certain stages with an MRI (magnetic resonance imaging) or a PET-CT, in order to be able to determine the best therapy. (Spread, involvement of neighboring organs, spread to other parts of the body).
Treatment for cervical cancer
The treatment of cervical cancer depends on the stage of the tumor and the age or general condition of the patient and should, if possible, be carried out by experienced specialists in gynecological oncology. In the case of precancerous lesions and early-stage cervical cancer, surgery is usually sufficient to achieve a cure.
If the tumor has already spread in the cervix but has not yet attacked other parts of the vagina or pelvis, surgery is also the best therapy here. Radiochemotherapy may follow the operation. Neoadvanced chemotherapy (chemo before surgery) is also possible to reduce the risk of recurrence (recurrence of the disease).
If the cervical cancer spreads beyond the cervix, a decision must be made on a case-by-case basis as to whether surgery is still an option or whether radiochemotherapy, chemotherapy or radiation therapy is a more gentle treatment for the patient and thus maintains a better quality of life.
Treatment of precancerous lesions
Precancerous lesions of cervical cancer (CIN) can be checked regularly by the gynecologist for 24 months. They can regress on their own but can also progress. After that, this precancerous lesion should be surgically removed. This can be done either locally by cutting out the affected tissue (if you want to have children) or by removing the entire uterus (hysterectomy). Here, too, each individual case must be considered separately. In a discussion with experienced specialists at a gynecological cancer center or dysplasia center, the patient's wishes are weighed against the individual options and risks.
Treatment of cervical cancer in the early stages
In the early stages, as with precancerous conditions, excision of the tumor (conization) may be sufficient. The affected tissue is removed with a knife or electric loop and examined by a pathologist. If the edges of the cut are free of tumor tissue, a 98% cure can be expected.
In exceptional cases, if you want to have children, it is also possible to preserve the uterus. You should discuss this option individually with your gynecologist. He or she will explain to you the options for fertility-preserving operations and the associated risks.
Treatment of cervical cancer that has spread beyond the cervix
In the later stages of cervical cancer, conization (usually an outpatient surgical procedure on the cervix) is no longer sufficient. Depending on the extent of the infection, the uterus, parts of the vagina, ovaries and affected areas of the bladder and intestines must also be removed. However, this is always decided on a case-by-case basis. Non-surgical therapy consisting of radiochemotherapy, chemotherapy, radiation or brachytherapy is usually recommended.
The doctors at a cancer center decide in a so-called tumor conference which non-surgical treatment for cervical cancer in the later stages offers the best chances and has the least impact on the patient's quality of life.
What are the chances of curing cervical cancer?
The prognosis for cervical cancer is excellent if treated in the early stages. If the uterus is removed, a 95-100% cure rate can be expected. In advanced stages, the cure rate drops significantly.
Regular check-ups and follow-up examinations are important after treatment in order to detect and treat any possible recurrence of the tumor as early as possible.
Primary prevention plays a major role. Regular check-ups, adequate genital hygiene of sexual partners, circumcision and the use of condoms are helpful here.
Cancer screening helps with early detection and vaccination protects against new cases
Every woman who regularly goes to the gynecologist knows the cotton swab test (Pap test), which is used to take a smear from the cervix and then examine it. It is thanks to this test, among other things, that the number of cervical cancer cases has steadily decreased in recent years.
However, good screening tests are also increasingly detecting early forms of cervical cancer. The peak incidence of cervical cancer is between 35-40 and 60-65 years.
By identifying various risk factors and causes, a vaccine has been brought onto the market in recent years that is intended to prevent infection with the HPV virus (human papillomavirus). This virus is responsible for 70% of cases of cervical cancer. The vaccination is recommended for girls between the ages of 12 and 17 who, ideally, have not yet had sexual intercourse.
