Cervical cancer
Cervical cancer: Description
Cervical cancer, also called cervical carcinoma, is a proliferation of malignant cells in the cervix, which forms the connection from the uterine corpus to the vagina. The composition of the mucous membrane of the cervix is different from the mucous membrane of the uterus. The cells in the area where the two different tissue types merge are vulnerable as a result of this heterogeneity. Infections from certain viruses can trigger the cancer (see below), but the infection itself rarely leads to a tumor. Cervical cancer and its precursors occur very frequently in women, however early preventive measures can prevent over 90 percent of carcinomas. Young women who receive a vaccination can minimize the likelihood of infection by the viruses that trigger the disease.
Cervical cancer: Symptoms
In its early stage, cervical cancer can develop without discomfort and asymptomatically. Moreover, first signs such as an often unpleasant smelling vaginal discharge, bleeding after sexual intercourse, pain during coitus or bleeding outside the menstrual cycle ("spotting") may initially point to other diseases. These symptoms should be investigated immediately in order to distinguish possible cancer from a benign disease or inflammation.
In advanced stages of cervical cancer there may be pains in the pelvic area during urination and defecation, and lymphostasis in the legs may also result.
Cervical cancer: Causes and Risks
One of the most common and important causes in the development of cervical cancer is infection with the human papilloma virus (HPV). In the area of the cervix there is a particularly strong proliferation of viruses that contribute to the formation of malignant tumor cells. Human papilloma virus is usually transmitted through sexual intercourse, against which even protection with condoms does not suffice, since infection with the virus can occur through skin contact in the genital areas. In rare cases there may be infection during birth or through physical contact with contaminated people.
Further risk factors in the development of cervical cancer are nicotine abuse, genital infections, frequent change of partners, a weakened immune system or other sexually transmitted diseases.
Cervical cancer: Examination and Diagnosis
As always, regular check-ups with a gynecologist are one of the most important preventive measures. In a screening, smears from the mucous membrane of the cervix and cervical canal can be taken for further histological examination. If a change in the mucosal cells is detected (PAP test), and this raises suspicions of a precursor or of cervical cancer itself, more tests such as a colposcopy, ultrasound or X-ray examination will be arranged. With invasive cancers a cysto- or rectoscopy is recommended to evaluate the extent of the tumor and rule out its possible intrusion into the bladder or rectum.
Cervical cancer: Treatment
The treatment of cervical cancer and its precursors depends on the stage of the disease and in part on individual factors. In the early stages a conization is sufficient treatment. With invasive tumors, a Wertheim-Meigs operation is performed endoscopically. Radiation therapy and chemotherapy, or a combination thereof (chemoradiotherapy), can be employed as alternative or supporting methods.
Cervical cancer: Course and Prognosis
With an early diagnosis of cancer, the chances of recovery are very good. Through regular check-ups, cell changes (dysplasia) can be detected in good time.
Vaccination against HPV viruses serves in preventing cervical cancer, but not in the prevention of uterine cancer.
In cases of recurring illness, the treatment depends on the diagnostic findings and the preceding therapies; here too, both radiation and chemotherapy or combined radiochemotherapy can be used. It is also possible in such cases to receive intraoperative radiotherapy in the Department of Obstetrics and Gynecology at the Medical Center - University of Freiburg.