Cervical cancer (cervical carcinoma) describes a type of cancer in women in which tumors develop on the lower part of the uterus – the cervix. The first symptoms can be discharge and intermittent bleeding. Screening usually makes it possible to detect and cure the cancer at an early stage. However, if treatment is not carried out early, the chances of cure decrease and fatal courses are possible. In addition to screening for early detection, cervical cancer vaccination is one way to prevent the risk of developing the cancer. Cancer: these symptoms can be warning signs
What is cervical cancer?
Cervical cancer, also known as cervical carcinoma, is a tumor disease of the lower part of the uterus: the cervix. This is a tubular connection lined with mucous membrane between the uterus and the vagina. At its lowest end, i.e. the exit of the cervix into the vagina, is the cervix. Tissue changes at the cervix are often a precursor to cervical cancer. Often, these precursors can be detected during a screening exam and then treated appropriately. In addition, cervical cancer vaccination (HPV vaccination) helps prevent the risk of developing cervical cancer. Cervical cancer – Getty Images/newannyart
How common is cervical cancer?
Cervical cancer is the tenth most common female tumor, with about 4,400 women developing it in Germany each year. In 2020, cervical cancer was the cancer responsible for the third most deaths in women worldwide (after breast cancer and lung cancer). Encouragingly, new cases and death rates are down compared to the 1970s, for example, and more tumors are being detected at an early stage (about four in ten women are diagnosed at stage I), giving them a better prognosis. This once again underscores the importance of early cancer detection examinations. The statistical average age at diagnosis has two peaks: at 20 and 55 years.
Causes: How does cervical cancer develop?
Cervical cancer is one of the cancers whose development can be promoted by a virus. Therefore, the human papillomavirus (HPV) is considered the central cause. It is probably only through infection with certain “high-risk” HPV types that tumors develop at all, although not every infection necessarily means that a woman will subsequently develop cervical cancer. The virus is contagious – transmission occurs through skin contact in the intimate area or during sexual intercourse. Risk factors for infection with papillomavirus are therefore unprotected and early sexual intercourse, a large number of different sexual partners and poor sexual hygiene – in countries where many men are circumcised, the tumor occurs less frequently. Other factors that promote cancer development in addition to HPV infection are:
- Taking the “pill” for a long period of time.
- A high number of pregnancies and births
- Immune deficiencies, such as those caused by disease, medication or an organ transplant
- Smoking
- Possibly other infections in the genital area with other pathogens, such as herpes simplex or chlamydia.
The influence of poor nutritional status and genetic factors are currently still under discussion. Precursors of cervical cancer are usually tissue changes (dysplasia) of the mucosa in the area of the cervix. It often takes several years or even decades for this to develop into cancer.
Symptoms of cervical cancer
Often, cervical cancer has few or no symptoms until late in the disease. Possible signs by which the cancer can be recognized are:
- Discharge, which may smell foul or appear flesh-water colored.
- Bleeding between periods, that is, bleeding outside of the period, after sexual intercourse or after the onset of menopause
- General symptoms such as fatigue, weight loss and night sweats.
- Discomfort of surrounding organs such as the bladder and kidney – for example, pain during urination or defecation, in the area of the lower abdomen, back and pelvis
- Unexplained swelling in one or both legs
Since most symptoms of cervical cancer appear very late, it is enormously important to regularly perceive the cancer screening examinations at the gynecologist.
How is the diagnosis made?
Cervical cancer or its precursors are often discovered during a screening exam. In this process, the doctor first asks about the patient’s medical history. This is followed by a gynecologic examination, during which the vagina and cervix are inspected and palpated. An appropriate instrument (speculum) allows the tissue at the cervix to be viewed.
Pap test: smear also shows precancerous lesions
As part of the cancer screening, a smear is taken from the cervix or os, which is examined for cell changes. This smear is called a “Pap test” or “Pap smear.” Important to know: An abnormal finding on the Pap test is not yet a diagnosis of cancer. The results are expressed as Pap I through Pap V:
- Pap I: normal, healthy cells.
- Pap II: slight cell changes without suspicion of cancer.
- Pap III: unclear findings, further examinations are necessary.
- Pap IIID: dysplasia present, but no cancer.
- Pap IV: precancerous lesions or cancer are possible, further examinations are necessary
- Pap V: malignant tumor cells, cancer is very likely.
Colposcopy, biopsy and HPV test.
Depending on the findings, the cervix and vaginal mucosa can also be viewed under magnifying glass (colposcopy) and changes can be visualized by staining the mucosa. If an area is conspicuously changed, a piece of tissue is specifically removed from the cervix and examined under the microscope as part of a biopsy during colposcopy. An HPV test can also be performed to determine if there is an infection with the human papillomavirus at all.
Biopsy findings: precancerous lesions of the cervix
There are three grades of cervical cancer precursors, in which the cells are already altered but do not yet show cancerous growth. These may have some likelihood of progressing to cancer after some time. The grades are determined based on a tissue sample taken (biopsy):
- Light (CIN 1)
- Moderate (CIN 2)
- High grade (CIN 3)
The abbreviation CIN stands for cervical intraepithelial neoplasia. This refers to changes in the cervix that are limited to the mucosa. Mild and moderate stages often regress on their own without treatment. In this case, it may be sufficient to wait and observe. High-grade dysplasia, however, develops into cervical cancer in about half of all cases and should therefore be treated.
Further examinations for cervical cancer
If the suspicion of cervical cancer is confirmed, “surgical staging” is used to find out how far the cancer has spread into the abdomen. This involves surgically removing tissue samples, such as suspicious lymph nodes. This is done with the help of a laparoscopy or a larger abdominal incision (laparotomy). If the cervical cancer is advanced, imaging procedures such as sonography (ultrasound), X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) may be needed to determine tumor spread and detect daughter tumors (metastases).
Cervical cancer: what forms of cancer are there?
The carcinoma itself usually originates from the so-called squamous epithelium, i.e. the covering cells of the mucosa, and is then referred to as squamous cell carcinoma. Other tumor types are the so-called adenocarcinomas, which arise from glandular cells. They are less common (about 20 percent of cases), but often have a worse prognosis. The cancer type is further classified according to size, spread, presence of metastases, microscopic findings and other criteria. Depending on the classification, different stages are distinguished, which are decisive for the choice of the right therapy, among other things. Carcinoma in situ (Latin: at the site) is the term used when cancer cells are present that have not yet spread. If there has already been spread to surrounding tissue, it is referred to as invasive cervical cancer.
Cervical cancer: therapy
The treatment of cervical cancer depends primarily on the stage and type of cancer and its spread, but also on the general condition and life situation of the patient. For example, whether the affected woman is already in menopause or whether she wishes to have children plays a role in the choice of the right therapy. In the case of many precancerous lesions, it is sufficient to check the findings at six-month intervals. In more advanced cases, surgery is usually required to remove the affected tissue. Surgical measures range from cone-shaped excision of the affected piece of tissue (conization) in the case of minor changes to hysterectomy, i.e. removal of the uterus (leaving the ovaries in place if possible). If the tumor has spread, surrounding tissues such as the lymph nodes may also need to be removed. In addition or as an alternative, radiation (radiotherapy or radiation therapy) is used, often in combination with chemotherapy. In addition, medications may be used to relieve side effects resulting from treatment or discomfort from the cancer itself. Psychological care and rehab after cancer treatment are also part of the therapy. If the cervical cancer is already far advanced and no longer curable, palliative therapy is used to try to alleviate the discomfort and maintain the quality of life as best as possible.
Prognosis: What are the chances of survival?
The prognosis is very good for cervical carcinoma or its precursors detected at an early stage. The earlier the cancer is detected, the higher the chances of cure. However, life expectancy decreases if the cancer has already spread. If the cancer is fully developed and has already grown into surrounding tissue, an average of 67 percent of patients survive the first 5 years after diagnosis. The 10-year survival rate is 63 percent. Regular follow-up examinations should be performed to monitor whether the cancer recurs.
Preventing cervical cancer with HPV vaccination.
The Permanent Vaccination Commission (STIKO) of the Robert Koch Institute recommends vaccination against human papillomavirus (HPV) as a standard vaccination for girls and young women aged 9 to 14 years to prevent cervical cancer. HPV vaccination reduces the risk of developing cervical cancer. Ideally, the two vaccinations should be given 5 months apart and completed before the first sexual intercourse. There is no complete protection until both doses have been administered. The cervical cancer vaccine is not effective against pre-existing HPV infections. Missed vaccinations should be made up by age 18. A third dose of vaccine is required for catch-up vaccinations over the age of 14 or if the interval between the first and second doses is less than 5 months. In addition to vaccination, the same measures are recommended to prevent HPV infection as to prevent sexually transmitted diseases. Screening also plays an important role in preventing cervical cancer.
Early detection through screening
For early detection of cervical cancer, women between the ages of 20 and 34 are entitled to a Pap test, i.e., a Pap smear followed by examination under a microscope, once a year. If necessary, further examinations can follow. From the age of 35, the Pap smear is then covered by statutory health insurance every three years in combination with an HPV test, i.e. a test for certain HP viruses. Since the beginning of 2020, women between the ages of 20 and 65 have been invited in writing every five years by their health insurer to undergo this screening examination. Important to know: Despite vaccination, cervical cancer may develop in rare cases. Vaccinated women should therefore also take advantage of the preventive examinations.
HPV vaccination also recommended for boys
Also for boys aged 9 to 14 years, vaccination against HPV is recommended on the part of the STIKO, the follow-up vaccination is advisable until the age of 17 years. The reason is, on the one hand, that boys and men can spread the virus and thus infect girls or women. On the other hand, they themselves are also protected by the vaccination, because the HP virus can also cause cancer in them, such as penile cancer, anal cancer or oral pharyngeal cancer.In addition, the human papillomavirus is the trigger of genital warts, a sexually transmitted disease that can affect both men and women. Discharge: normal, heavy or colored – what does it mean?
