Cervical Cancer

The cervix is the connection between the vagina and the uterine cavity and refers to the lower part of the uterus. The end of the cervix is represented by the uterine orifice (portio vaginalis uteri), which can be seen in the upper part of the vagina during the lower abdominal gynaecological examination.

The cervix is covered by a skin that shows some changes compared to the mucous membrane of the cervix. The junction between the cervix and the cervical os is prone to cell changes (dysplasia). If such a change occurs and it is malignant or the cells spread into the surrounding tissue, it is called cervical cancer.

Due to early detection screening, cervical cancer cases have decreased in recent years. Within one year, it is estimated that there are about 6200 new cases in Germany.

Cervical carcinoma is the second most common cancer of the female genitals, after cervical cancer.

Various subtypes of the human papilloma virus (HPV), which are transmitted through sexual contact, are considered to be the triggers for cervical cancer. Particularly at risk are the so-called "high-risk groups" of the human papilloma virus of subgroups 16,18,31,33,45,51,52 and 56. In addition, other risk factors contribute to the development of cervical cancer. These include an early time of first sexual intercourse and frequently changing sexual partners. It has not yet been shown whether smoking or other genital infections also increase the risk of the disease.

In most cases, the immune system can cope with these viruses within a short time. However, it is also possible that some viruses survive and contribute to the cells of the cervix eventually turning into cancer cells years later.

Initially, those affected do not suffer from any symptoms. The cell changes (dysplasia) are also not noticeable, but can be diagnosed by a preliminary gynaecological examination.

In the later course, the following symptoms occur:

• Spotting during sexual intercourse
• Flesh-water coloured, sometimes also bloody discharge
• Pain caused by the spread of the cancer to the surrounding organs

In the early stages, cervical cancer can be detected by a smear test, a cell sample or a colposcopy. Colposcopy is an examination method in which the gynaecologist examines the surface of the cervix (portio vaginalis uteri) using a magnifying glass.

If preliminary stages of cell changes remain unnoticed, they can continue to multiply unhindered. Some of these cells can be aggressive and penetrate deeper into the environment. In the later stages, cervical cancer can be detected with the help of a speculum (vaginal mirror) with the naked eye.

Once there is a confirmed diagnosis of cervical cancer, further measures are taken to prevent the cancer from spreading:

• Ultrasound examinations (sonography) of the abdomen
• X-ray examinations
• Cystoscopy (examination of the bladder)
• Colonoscopy (rectoscopy)
• Conical excision of the cervix (conisation)
• Scraping of the uterus (curettage)
• Computer tomography (CT)
• Magnetic resonance imaging (MRT)

Tumour markers can also be measured in the blood. Here, particular attention should be paid to the tumour marker SCC (Squamous Cell Carcinoma Antigen), which is produced by cervical cancer from time to time.

Early stage:

If cervical cancer is diagnosed in the early stages, surgery is usually performed. First, the suspicion must be confirmed by taking a tissue sample.

If the cancer is detected very early, a cone-shaped excision of the affected tissue (conisation) is often sufficient. This method ensures that the woman can still have children later. Normally, this method is combined with a curettage of the uterus. During this procedure, the doctor removes the superficial layer of mucous membrane that serves to line the uterus. However, if cell changes are already found in the depths, the entire uterus must be removed.

Advanced stages:

If the cervical cancer is already in an advanced stage, it may be necessary to radically remove the entire uterus (Wertheim-Meigs surgery). The uterus, the supporting apparatus and the lymph nodes along the large pelvic vessels are removed. The additional removal of the fallopian tubes and ovaries is usually not necessary and is avoided, especially in younger women.

In some cases, additional chemotherapy or radiation treatment is necessary after the operation. According to recent scientific studies, the use of both methods gives a higher chance of cure, as the chemotherapeutic drugs make the cancer more susceptible to radiation.

Also with cervical cancer, as with all cancers, the probability of cure is highest when the cancer is diagnosed in the early stages. Five years after diagnosis, 61 percent of patients still survive (5-year survival rate).

The chances of cure are almost 100 percent if the cancer is detected and treated in its early stages.

Cervical cancer can be classified based on the detection of high-risk HPV and the PAP smear. The results that come from these tests help to assess and treat the cancer.

In order to avoid cervical cancer, vaccination against HPV infection is useful. In addition, the use of a condom during sexual contact is important to prevent the transmission of HP viruses. Since November 2007, it has been possible for girls between the ages of 12 and 17 to be vaccinated against HP viruses. The vaccination immunizes against the high-risk genotypes 16, 18, 6 and 11, which also cause genital warts. HPV vaccination prevents infection with HP viruses and thus significantly reduces the risk of developing cervical cancer.

In order to detect cervical cancer at an early stage, regular preliminary gynaecological examinations are essential. During this examination, a smear is taken from the cervix and examined for suspicious cells.

Despite vaccination, the preliminary examination should be carried out, as in some cases other types of virus also trigger cervical cancer. In addition, the screening can also detect other diseases.