Every year in Switzerland, around 260 women develop cervical cancer¹. There are also around 5,000 women in whom cell changes are detected. "It can take years for a malignant tumour to develop from slight cell changes in the cervix," says Dr Gian-Piero Ghisu, Senior Physician with extended responsibility at the Clinic for Gynecology at the University Hospital of Zürich.
In the early stages of cervical cancer, the cells in the lining of the uterus change. They divide faster and look different from normal cells. "They are already cancer-like cells. This is why we talk about cancer precursors." Specialists distinguish three stages of cell changes.
Watch Dina talk about her experience together with Gian-Piero Ghisu, Senior Physician in the Department of Gynecology at the University Hospital of Zürich. She talks about the causes of the disease and treatment options.
In the first two precancerous stages, it is rather unlikely that a cancer will develop.² "You have to take these changes seriously, but there is no reason to worry," says Dr Ghisu. "It's worth waiting. In more than half of cases, the cell changes resolve themselves."
In the case of the third precursor, a conization of the cervix is generally performed. A conical piece of the cervix containing the altered tissue is removed. "Conization is not sufficient for larger and more advanced tumours. Depending on the stage of the tumour, more radical surgery may be necessary, although the body of the uterus can be maintained so pregnancy is still possible in the future. Sometimes, however, removal of the uterus is unavoidable or radiochemotherapy may even need to be discussed."
The main cause of cervical cancer is infection with certain human papillomaviruses (HPV), which are almost exclusively sexually transmitted. "There are about 200 different HP viruses, 12-15 of which can cause cancer and are called high-risk types." Approximately 70 percent of all women are infected with HPV, and in most cases these viruses do not cause symptoms.² "In around 90 percent of all infected people, the body's own immune system eliminates the viruses after a maximum of two years," says Dr Ghisu. "For the other 10% or so, the infections can last longer and may lead to precancerous stages or cervical cancer."
Sexual intercourse at a very young age and frequent changes in sexual partners increase the risk of coming into contact with HPV. "Vaccination can protect against infection with some HP viruses," says Dr Ghisu. "This should be done before the first episode of sexual intercourse, if possible, but is also sensible afterwards."
The FOPH therefore recommends HPV vaccination for all adolescents aged 11 to 14 years. Under the cantonal vaccination programs, vaccination of 11 to 26-year-old women and men is free of charge in accordance with the FOPH recommendations.3
Although HPV-associated diseases are more common in women than in men, vaccination is recommended as an additional vaccination for 11 to 26-year-old men.3 While men cannot develop cervical cancer, other serious consequences of the infection such as penile cancer, anal cancer or head and neck tumours can occur in men.4 Genital warts caused by HPV occur in women and men.
There is no treatment for HP viruses. Prevention is crucial. "I recommend vaccination, because this is how most diseases can be prevented," says Dr Ghisu.
The risk of developing cervical cancer increases with further infections such as chlamydia or herpes simplex.² In the case of women smokers, pathogens can also penetrate more easily into the cells of the mucosa. "If a woman already has a precursor of cervical cancer, she should absolutely abstain from nicotine," says Dr Ghisu. "I also recommend exercise, a healthy diet and avoiding stress."
In so many cases, cervical cancer does not cause any symptoms. That is why cancer prevention is extremely important for the gynaecologist. "In this way, cancer precursors can be detected and treated in a timely fashion before it is too late," says Dr Ghisu. "If you go for a checkup every three years, you have a good chance of detecting changes to the cervix early."
Cervical cancer screening is based on regular cervical swab sampling. There have been two screening methods for a number of years: in Germany, the investigation for cell changes ("Pap smear") is usually used. The newer and more sensitive test method used in many neighbouring European countries is based on an HPV test. However, compulsory basic insurance in Switzerland does not currently cover the costs of screening with the HPV test. The Cancer League is calling for the HPV test to be adopted as part of the screening for women aged between 30 and 70, and efforts are under way for the HPV test to be reimbursed by the insurance company in the future.5
HPV was also the cause of the disease in former Bachelorette Dina. When the woman from Bern was diagnosed with cervical cancer five years ago, her world collapsed. "Tears came to my eyes and I was afraid for my life." She waited to do the surgery hoping that the disease would regress. "Every three months, I had to go to check to see if the cells had changed." After two years, the doctor recommended that she have surgery.
"In early-stage cervical cancer, the uterus can often be preserved," says Dr Ghisu. "In advanced stages, the uterus usually needs to be removed or radiochemotherapy performed." For Dina, only the affected part of the uterus was removed using a procedure called conization - a conscious decision. "I didn't want to have the whole uterus removed because I wanted the opportunity to have another child."
The surgery in the hospital was a very stressful time for the former Miss Bern contestant. "I felt very bad, I was physically exhausted after the operation." At the same time, though, she was also very relieved. "Knowing that there's nothing harmful in my body motivated me and brought back my zest for life."
When the doctor confirmed for her a few weeks later that the surgery had been successful and that the altered tissue was removed, a new life began for the 31-year-old. "It felt like a rebirth, it was a giant gift." Dina thinks about the positive side of her cancer. "When I complain about little things, I have to remind myself how much good I have in my life and how well I have managed this difficult time."
Today's health systems are based on data that have been largely collected and processed by men for men. This leads to a bias in terms of women's experiences and needs.
You can find more
Swiss Cancer League | Cervical cancer
University Hospital of Zürich | Cervical cancer
Federal Office of Public Health | Human Papillomaviruses
MSD health portal | HPV in boys and men
Swiss Cancer League | Press release on cervical cancer screening
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