Cervical cancer
Cervical cancer has become rare in Switzerland thanks to widespread early detection. In Switzerland, around 250 women are newly diagnosed with cervical cancer each year, and around 75 women die as a result of the disease. Cervical cancer is almost always caused by human papillomavirus (HPV), and there is practically no hereditary cause. In addition to early detection, vaccination against HPV could further reduce the rate of new cases, but the vaccination participation of the target group (girls and boys up to a maximum of 26 years of age) is below 50%, so this will only have a hesitant effect.
The precancerous stage to cervical cancer, on the other hand, is very often identified and usually successfully and sustainably treated with a so-called conization. Those affected with cervical cancer were either not recognized in time during the early detection or they did not go to early detection. Most women with cervical cancer are between 45 and 65 years old, but there are also younger women who have not yet completed family planning. In general, the prognosis is good, but the rarity of the diagnosis makes it difficult to find doctors with sufficient experience in the treatment. Cervical cancer usually manifests itself as irregular bleeding.
Therapy of cervical cancer
In general, in the earlier stages, radiation therapy and surgery are equivalent in terms of prognosis. However, it is not uncommon for both therapies to have long-term effects, which are more pronounced with radiation therapy than with surgery. In this respect, surgery is preferred in the early stages in Switzerland. In advanced stages, on the other hand, radiation therapy is primarily used, usually in combination with chemotherapy.
Surgical techniques
The introduction of radical hysterectomy by Prof. Wertheim in Vienna was revolutionary more than 100 years ago, when cervical cancer was by far the most common cancer in women, which is why the term Wertheim operation has become known. The actual Wertheim operation has not been performed for decades and has been significantly improved by many experts, so that today there is unfortunately a variety of terms for the surgical techniques. The aim of the operation is to remove the cervix with a sufficient safety margin in all directions, to examine the lymphatic system and to avoid damaging any adjacent structures such as nerves. In the very early stages, a conization may be sufficient, such as in the precancerous stage. If you wish to have children, only the cervix with the adjacent tissue of the vagina and the supporting apparatus of the uterus (parametria) can be removed in the early stages, the so-called trachelectomy. Once the family planning has been completed, the uterus is practically always removed, usually together with the parametria and the adjacent upper section of the vagina. The ovaries do not necessarily have to be removed. The nerves are spared as much as possible, but it can still happen that women no longer have a feeling for the bladder after the operation and are either incontinent or have to catheterize themselves. Today, the lymph nodes no longer necessarily have to be radically removed; if sentinel lymph nodes can be found, then a radical removal may not take place. If the lymph nodes are affected, however, radiation should follow and the uterus is even left in place. The procedure is quite complex in each individual case and must be discussed in detail with the patient.
Radiation therapy – chemoradiotherapy
In advanced stages or when surgery is not possible for other reasons, the treatment of cervical cancer with radiation therapy shows a very good response. The effectiveness of radiation therapy can be improved by chemotherapy given in parallel, which is dosed in lower doses than usual. The side effects are sometimes not insignificant, but also as late effects during therapy, e.g. in the form of diarrhea.
Advanced cervical cancer
In the advanced stage as well as with metastases, the therapy options are unfortunately limited so far. Systems therapy such as chemotherapy can be tried. The chances of success are, however, moderately good. The therapy can be supplemented by antibodies (bevacizumab), which can delay the course of the disease. If the tumor has only spread in the small pelvis, then very radical operations can be considered, in which the bladder and also the rectum are partly removed (so-called exenterations). These are of course significantly impairing the quality of life in the long term. If radiation has not yet taken place, this can be used, often in combination with supportive chemotherapy.
Outlook
In Switzerland, the more gentle laparoscopy has prevailed in surgical therapy, but it has not been finally clarified whether this has the same security as the radical removal of the uterus by means of an abdominal incision and current study results raise doubts here. The sentinel lymph node method, on the other hand, will hopefully soon become widespread, which has fewer long-term consequences than the radical removal of the pelvic lymph nodes. For only very few people with cervical cancer who wish to have children, the uterine transplant will be an option, as it has already been carried out in Sweden with positive experience. There are developments in this direction in Switzerland, but the need is very small.
Even if antibodies against new blood vessels (bevacizumab) have shown improvements in the course of the disease in advanced cervical cancer, unfortunately we cannot expect any outstanding innovations in therapy in the foreseeable future. Prevention therefore appears to be much more important, namely increasing the vaccination rate and optimizing early detection through HPV-based screening.