Cervical cancer

Cervical cancer is a malignant change in the tissue of the cervix, usually in the area of ​​the cervix

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Female anatomy: The cervix connects the uterus to the vagina. It ends in the cervix, which protrudes a little bit into the vagina (please click on the magnifying glass to enlarge the graphic!)

© W & B / Ulrike Möhle

Cervical cancer - briefly explained

In around 70 percent of cases, the cause of cervical cancer is an infection with human papillomaviruses (HPV) of type 16 or 18. The malignant changes in the cervix usually do not initially cause symptoms. It is therefore important for women over the age of 20 to attend the annual preventive medical check-up at the gynecologist. At the age of 20 to 34, a so-called Pap test is provided, in which a smear from the cervix is ​​examined for tissue changes. From the age of 35, a smear is taken every three years and also checked for HPV. If there is cervical cancer, the tumor is completely surgically removed if possible. In addition to the operation, radiation and / or chemotherapy may be necessary.

Definition: what is cervical cancer

The cervix, known as the cervix uteri (or cervix uteri), is the lower part of the uterus. It connects the uterus with the vagina and ends in the cervix (portio), which protrudes into the vagina.

At the cervix is ​​the transition area between the glandular mucous membrane of the cervical canal and the mucous membrane that covers the outer parts of the cervix. This area is particularly prone to cell changes. If these are malignant, one speaks of cervical cancer or cervical cancer.

At what age does cervical cancer occur?

Compared to many other cancers, cervical cancer occurs in younger women. In 2016, 4,380 women in Germany were newly diagnosed with cervical cancer. Half of those affected are younger than 55 years of age (mean age of onset) when they are first diagnosed with cervical carcinoma that has penetrated the surrounding tissue and thus can develop metastases (invasive carcinoma). As part of early detection, cancer precursors and early stages, so-called in-situ carcinomas, are often found in women in their mid-thirties.

Causes: What Causes Cervical Cancer?

An infection with certain types of the so-called human papillomavirus (HPV) is a prerequisite for the development of cervical cancer. The viruses are mainly transmitted during sexual intercourse. In most cases, the immune system fights the pathogens within a short period of time. However, sometimes the viruses survive the attack of the immune system and persist in the cells of the cervical lining. In some cases, this can lead to cell changes and, in the long term, via precancerous stages, ultimately to cancer. So cervical cancer is the rare consequence of infection.

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There are many different types of human papillomavirus (HPV). Part of it has the ability to cause cancer. HPV 16 and HPV 18 are particularly problematic: They are responsible for around 70 percent of cervical cancer cases. It is now known how these viruses lead to the development of cervical cancer. Certain proteins are produced in excess in the cell. The permanent activity of these "oncogenes" can lead to malignant changes in the cells of the cervix. If these pathologically altered cells are not recognized and treated at an early stage, cervical cancer can result. This process usually takes many years.

The virus is mainly transmitted during sexual intercourse. Most sexually active women contract the virus at least once in their lives. Unprotected sexual intercourse with frequently changing partners increases the risk of infection considerably. Once an HPV infection has been passed through, a renewed infection with the same virus cannot be completely ruled out because the infection passed through usually does not provide reliable, lasting protection.

Symptoms: what are the signs of cervical cancer?

Cervical cancer does not initially cause symptoms and is therefore often not noticed for a long time. Symptoms usually only appear when the disease is more advanced. Infection with human papillomaviruses also usually goes unnoticed. It is precisely because of the lack of early symptoms that annual cancer screening by the gynecologist can be useful from the age of 20.
Symptoms that may occur with cervical cancer:

  • Bleeding after intercourse
  • Bleeding or spotting outside the menstrual cycle
  • bloody, often foul-smelling discharge
  • Pain during sex
  • Pelvic pain

If the carcinoma has grown into the surrounding tissue, symptoms such as

  • Blood in the urine
  • Urinary tract infections
  • Back pain
  • or lymphatic congestion.

Unintentional and inexplicable, significant weight loss can also be a sign of advanced cancer.

Early detection of cervical cancer

The statutory health insurance companies pay all women over the age of 20 an annual preventive check-up at the gynecologist.

Women between 20 and 34 years of age can have the so-called Pap test carried out. The gynecologist takes a swab from the cervix and has it examined for cell changes.

Women aged 35 and over can have a smear test every three years. This is then examined both for changes in the cells (Pap test) and for HPV.

Further tests can follow depending on the result. These preventive examinations are also important for women who have been vaccinated against HPV, as the vaccination does not offer 100% protection against cervical cancer.

Regardless of this, a gynecologist should always be consulted if

  • Vaginal discharge,
  • Bleeding outside of your period or
  • Lower abdominal pain

occur. Even if these symptoms are more likely to be caused by inflammation or hormonal disorders in most cases, they should still be clarified.

The Pap test helps detect cervical cancer and its precursors

© YourPhotoToday / A1Pix

diagnosis

If cervical cancer is suspected, the doctor looks at the cervix during the gynecological examination and takes a swab from there and from the cervical canal with a spatula and a small brush or spatula. The smears are then processed in the laboratory and examined for cell changes (so-called Pap test).

Pap test

The test, named after the Greek physician George Nicholas Papanicolaou, has been used for the early detection of cervical cancer since the mid-1940s. With the Pap test, symptom-free cancer precursors can be identified at an early stage and then treated effectively.

The smear can be prepared conventionally for the Pap test or using the thin-layer method. In the conventional method, the cells are smeared onto a glass plate, fixed and examined under the microscope.

With the thin-layer method, the cells in the smear are dissolved in a liquid, freed from impurities and then spread very thinly and particularly evenly on a slide. The aim is to create optimal conditions for microscopic assessment. This examination is also suitable for detecting cell changes and cervical cancer. However, there is currently insufficient evidence that it is superior to the conventional method.

The findings of the smear are divided into five levels according to the extent of any cell changes:

Pap 0: The material could not be used. The smear should be repeated within three months.

Pap I: inconspicuous, normal findings. For most women, a routine check-up (one or three years, depending on age) is sufficient. Exception: If the HPV test is positive in women over 35 years of age, it should be checked after 12 months.

Pap IIa: normal findings. In the past, however, there was a noticeable result with this woman - so the doctor decides individually when the next check-up is necessary.

Pap II: Slight changes in the cells, which are often caused by germs or a hormone deficiency.

Pap IIID1: abnormal finding with slight changes in the mucous membrane (dysplasia). Often, especially in young women, the changes regress on their own.

The following applies to Pap II and Pap IIID: Depending on how old you are, how much the cells are changed and whether - in people over 35 - the HPV test is positive, the procedure is different. Nodules are possible in routine intervals or more short-term Pap smears and / or HPV tests or a vaginaloscopy within three months are possible every six or twelve months. Your doctor will inform you accordingly.

Pap III: unclear finding.

Pap IIID2: Moderate changes in the mucous membrane.

The following applies to Pap III and Pap IIID2: A vaginal examination (colposcopy) within three months is indicated for clarification.

Pap IV: pre-cancerous or possibly already cervical cancer.

Pap V: tumor cells are detectable in the smear.

The following applies to Pap IV and Pap V: An immediate vaginaloscopy (colposcopy) is necessary, during which a tissue sample is taken.

Examination for human papilloma viruses (HPV test)

The HPV test can show whether a woman is infected with cancer-causing papillomaviruses or not. Together with the smear result, the risk of cervical cancer can be better assessed. A swab from the cervix is ​​also necessary for the test. The laboratory examines whether the genetic material of human papillomaviruses can be detected in it, i.e. whether there is an infection. The HPV tests used for early detection have a limit value above which one assumes an increased risk of cancer.

If both the HPV test and the smear are normal, there is no risk of cancer precursors or even cancer developing in the years to come. The HPV test is currently used in women over 35 as part of the program for the early detection of cervical cancer. The doctor can also order it if the laboratory detects slight or unclear changes in the smear in young women. An HPV test is also part of the follow-up checks after the removal of a preliminary stage of cervical cancer by means of a so-called conization. If viruses continue to be detected, the risk of cell changes forming again is increased.

Colposcopy

In the so-called colposcopy or vaginal specimen, the gynecologist examines the mucous membrane of the cervix with the help of an illuminated magnifying glass and a mirror: the magnifying glass also shows very small changes with a magnification of up to 40 times.
Colposcopy is used in particular to clarify suspicious smears, in which case tissue samples are usually also taken. In advanced cases, cervical cancer can often be recognized with the naked eye.

biopsy

If the early detection tests reveal evidence of precancerous stages or cervical cancer, the gynecologist takes tissue samples from the suspected region as part of a colposcopic examination. This so-called biopsy is carried out using small forceps and is performed on an outpatient basis. In contrast to the Pap test, all layers of the mucous membrane of the cervix can be examined in detail on the tissue sample.