Cervical cancer (cervical carcinoma) ranks eleventh in the female tumor diseases, over 4, 700 women fall ill in Germany every year. It is encouraging that the number of new cases and the death rates since the 70s are decreasing, more tumors are detected in the early stages and thus have a better prognosis. This fact is all the more astonishing considering that the number of precancerous lesions from which cancer can develop has increased many times over. This underlines once again the importance of cancer screening tests. The statistical average age at diagnosis has two peaks: at 34 and 53 years.
Which types of cancer are there?
There are three different degrees of precancerous lesions (CIN I-III), in which the cells are already altered but have no cancerous growth. These may, with some likelihood, turn into cancer after some time.
The carcinoma itself usually originates from the capillaries of the mucous membrane (squamous cell carcinoma), other tumor types are rare, but often have a worse prognosis. The type of cancer is further classified according to size, spread, microscopic findings and other criteria.
Causes: How does cervical cancer develop?
It is now known that human papillomavirus (HPV) plays an important role in the development of cervical cancer. It is probably only by an infection with certain "high-risk" HPV types at all to a tumor development, whereby not every infection inevitably leads to such.
Unprotected and early sexual intercourse, a large number of different sexual partners and poor sexual hygiene increase the risk of infection - in countries where many men are circumcised, the tumor occurs less frequently.
Factors that promote cancer development are:
- taking the "pill" over a long period of time
- a high number of births
- genetic changes
The influence of smoking, a poor nutritional status and genital infections with other pathogens such as herpes or chlamydia is currently being discussed.
Symptoms of cervical cancer
Often, cervical cancer rarely shows symptoms. First signs are watery discharge and bleeding. If the tumor has progressed, general symptoms such as weight loss and night sweats can be added and complaints of the surrounding organs such as bladder and kidney.
Because most cervical cancer symptoms are late in life, it is very important to have regular cancer screening.
How is the diagnosis made?
First, the doctor will raise the medical history. This is followed by a gynecological examination in which the vagina and cervix are inspected and scanned. As part of the cancer screening is then a smear taken from the cervix or cervix, which is examined for cell changes ("PAP").
Depending on the findings, the cervix and the vaginal mucosa can also be viewed under magnification (colposcopy) and changes made visible by staining the mucous membrane.
If a district is noticeably altered, a piece of tissue from the cervix (and possibly surrounding lymph nodes) is removed and examined under the microscope. If cervix cancer has progressed, imaging techniques such as sonography, MRI or computed tomography may be indicated to determine tumor spread and detect secondary tumors.
Cervical cancer: prognosis and therapy
The treatment of cervix cancer depends mainly on the stage and type of cancer, but also on the general condition and the patient's life situation. For many precursors, it is sufficient to check the findings every 3 months.
Surgical measures range from the conical excision of the affected tissue piece (conization) to the "radical surgery", ie removal of the uterus (if possible, leaving the ovaries). If the tumor has spread, it may be necessary to remove surrounding tissue as well. In addition or as an alternative, radiation (radiotherapy) is used, often in combination with chemotherapy.
The prognosis is very good for an early discovered cervical carcinoma or its precursors. If the cancer is fully developed and has already grown into the surrounding tissue, on average 69 percent of the patients survive the first 5 years after diagnosis.
Prevent cervical cancer
The Standing Vaccination Committee (STIKO) of the Robert Koch Institute recommends vaccination against human papillomavirus (HPV) as a standard vaccine for girls and young women aged 9 to 14 years in order to prevent cervical cancer. HPV vaccination reduces the risk of developing cervical cancer.
The double vaccination should ideally be given at intervals of 5 months and completed before the first sexual intercourse. Complete protection exists only after administration of both doses. The vaccine does not work against existing HPV infections.
Missed vaccinations should be made up to the age of 18 years. In the case of vaccination after the age of 14 years or less than 5 months between the first and second dose, a third dose of vaccine is required.
HPV vaccine also recommended for boys
The STIKO recommends a vaccine against HPV for boys between the ages of 9 and 14, and the vaccine is recommended until the age of 17. One reason is that men can spread the virus. On the other hand, they are also protected by the vaccine, because the HP virus can also cause cancer, such as penile cancer, anal cancer or oropharyngeal cancer.