The cervix is the lower part of the womb (uterus). It is a strong muscular canal lined with a mucous membrane that has a lot of glands in it. The very bottom end of the cervix protrudes into the vagina a little, at the opening of the cervix. The glands in the mucous membrane produce a thick liquid (cervical mucus) that acts as a barrier, preventing germs from entering the womb from the vagina. Cervical cancer (medical term: cervical carcinoma) usually develops at the opening of the cervix, where the mucous membranes of the vagina and cervix meet. Most tumors develop from abnormal cells covering the cervical opening. That kind of tumor is called a squamous cell carcinoma. Cervical cancer can also develop from gland cells, but that is less common. Those tumors are called adenocarcinomas.
Symptoms
It usually takes years, if not decades, for abnormal cells to develop
into cervical cancer. These abnormal cells are not dangerous and do not
cause any, or only few, symptoms. If cancer has developed, women
sometimes have abnormal vaginal bleeding, for example after sexual
intercourse or after menopause.
Causes
Cervical cancer is a rare consequence of an infection with particular viruses, known as human papillomaviruses (HPV). These viruses are very common, so most women will have an HPV infection at some point in their lives. HPV infections
occur in humans only, affecting skin and mucous membrane cells. There
are more than 100 known types of HPV. About 40 of those infect the
genital area and can be sexually transmitted. They are spread through
contact with infected skin or mucous membrane cells, and most probably
not through contact with sperm, blood or saliva. Some of these viruses mainly multiply in the mucous membrane cells that line the opening of the cervix.
People do not usually notice that they have an HPV infection, and their immune system normally fights off the virus on its own. So the infection goes away without causing any problems. But particular types of HPV, known as high-risk types, sometimes lead to a persistent long-term infection of the mucous membranes. “HPV 16” and “HPV 18” are high-risk types of HPV.
They can affect the way in which cells divide, which makes those cells more susceptible to further damage. In rare cases these abnormal cells can develop into cancer over the course of years or decades.
People do not usually notice that they have an HPV infection, and their immune system normally fights off the virus on its own. So the infection goes away without causing any problems. But particular types of HPV, known as high-risk types, sometimes lead to a persistent long-term infection of the mucous membranes. “HPV 16” and “HPV 18” are high-risk types of HPV.
They can affect the way in which cells divide, which makes those cells more susceptible to further damage. In rare cases these abnormal cells can develop into cancer over the course of years or decades.
Risk factors
Certain groups of women are more likely to get cervical cancer than
others. For instance, women who smoke are at higher risk. This might be
because their immune systems are less effective at fighting the viruses. Because HPV is a sexually transmitted infection,
things that generally increase the risk of sexually transmitted
diseases are also considered to be risk factors for cervical cancer. So,
for example, the more sexual partners someone has, the higher their
risk of cervical cancer.
Frequency
About 4,800 women develop cervical cancer in Germany each year.
Roughly 90 out of 10,000 women will get cervical cancer in the course of
their lives. And about one third of those who develop cervical cancer
will die of the disease.
The risk of cervical cancer also depends on a woman’s age: it is most common in women between the ages of 40 and 50. About 16 to 18 out of 10,000 women in this age group will develop cervical cancer within the next ten years.
The following table will give you an idea of how age affects the risk. The numbers describe – for different ages – how many women out of 10,000 will die of cervical cancer within the next ten years.
The number of women who die from cervical cancer in Germany has decreased considerably over the last few decades. Possible reasons for this include a general improvement in living conditions and better hygiene, as well as the introduction of screening for cervical cancer in the 1970s.
The risk of cervical cancer also depends on a woman’s age: it is most common in women between the ages of 40 and 50. About 16 to 18 out of 10,000 women in this age group will develop cervical cancer within the next ten years.
The following table will give you an idea of how age affects the risk. The numbers describe – for different ages – how many women out of 10,000 will die of cervical cancer within the next ten years.
The number of women who die from cervical cancer in Germany has decreased considerably over the last few decades. Possible reasons for this include a general improvement in living conditions and better hygiene, as well as the introduction of screening for cervical cancer in the 1970s.
Screening
Even if a woman’s immune system does not manage to fight off an HPV infection,
it usually takes years or decades before infected mucous membrane cells
can develop into cancer. During this time the affected cells change
more and more, so they look different to normal cells under a
microscope. This fact can be used in screening for cervical cancer. A “Pap test” (or “smear test”) is used to get a sample of cells to examine.
For a number of years now, various chemical tests have been available to detect HPV in mucous membrane cells that have been removed. This kind of HPV test can help to determine whether a woman is at higher risk of cervical cancer. It cannot detect cancer, but it can be used to help prevent it.
For a number of years now, various chemical tests have been available to detect HPV in mucous membrane cells that have been removed. This kind of HPV test can help to determine whether a woman is at higher risk of cervical cancer. It cannot detect cancer, but it can be used to help prevent it.
Prevention
Cervical cancer nearly always develops as a rare consequence of a long-term infection with particular types of HPV.
So, at least theoretically, there are three ways to help prevent it:
Condoms can offer effective protection from many sexually transmitted diseases, so it definitely makes sense to use them if you have different sexual partners. But condoms do not offer 100% protection from HPV because they do not cover all of the possibly infected areas of skin in the genital region.
A vaccine is available for girls and women who have not yet been infected with HPV.
So, at least theoretically, there are three ways to help prevent it:
- Sexual abstinence or using condoms
- HPV vaccine
- Screening for abnormal cells that have not become cancerous
Condoms can offer effective protection from many sexually transmitted diseases, so it definitely makes sense to use them if you have different sexual partners. But condoms do not offer 100% protection from HPV because they do not cover all of the possibly infected areas of skin in the genital region.
A vaccine is available for girls and women who have not yet been infected with HPV.
Treatment
The most appropriate type of treatment will mainly depend on the size
of the tumor and how far the cancer has advanced. If the tumor is
discovered at a very early stage, a small surgical procedure
(conization) might be enough. If the tumor has already spread to the
surrounding tissue, doctors usually recommend having surgery to remove
the entire womb (a hysterectomy). The lymph nodes are removed in a wide
area around the womb too. Radiotherapy might also be considered.
Radiotherapy is still an option even if the tumor can no longer be
removed through surgery. In some patients it can be combined with
chemotherapy.