Die richtige Option wählen - Operation, Radio-, Chemo- oder Kombinationstherapie beim Zervixkarzinom?

Zusammenfassung

Jedem Zervixkarzinom liegt eine Infektion mit dem humanen Papillomavirus (HPV) zugrunde, deren virale Onkogene die Kanzerogenese induzieren. Tumore am Gebärmutterhals zählen zu den soliden Tumoren mit den besten Heilungsraten. Bezüglich der Mortalitätsraten schneidet Deutschland jedoch im internationalen Vergleich relativ schlecht ab, denn nicht einmal die Hälfte aller Frauen nehmen die angebotenen Früherkennungsmaßnahmen an. Und das, obwohl Zervixkarzinome relativ leicht auch in frühen Stadien zu diagnostizieren sind (HPV-Nachweis, Spiegeleinstellung, zytologischer Abstrich). Wie auch bei allen anderen Karzinomentitäten stehen mit der Operation, der Radiotherapie und der Chemotherapie grundsätzlich drei verschiedene Therapiestrategien zur Verfügung. Sind die Ergebnisse von Operation und Strahlentherapie in niedrigen Stadien I und II etwa vergleichbar, ändert sich das bei weiter fortgeschritteneren Tumoren: Hier ergeben sich für die Strahlentherapie bessere Resultate. Erst in den letzten fünf Jahren ist als weitere Therapieoption die systemische Chemotherapie (Mittel der Wahl ist Cisplatin) hinzugekommen. In kurativer Zielsetzung scheint jedoch nur eine kombinierte Radiochemotherapie effizient zu sein.

Summary

Underlying every cervical cancer is an infection with the human papillomavirus (HPV), the viral oncogenes of which induce carcinogenesis. Tumours of the cervix and among the solid tumours with the best cure rates. In international comparisons, however, Germany has relatively poor mortality rates, since less than one-half of all women take advantage of the early screening measures offered - and this despite the fact that carcinoma of the cervix is relatively easy to diagnose even in early stages (HPV detection, colposcopy, cytological swab). In common with all other types of carcinoma, three different therapeutic strategies are available, namely, surgery, radiotherapy and chemotherapy. While the results of surgery and radiotherapy are approximately comparable for stage I and stage II disease, the picture changes in more advanced tumours, where radiotherapy produces better results. Only in the last five years is a further therapeutic option - systemic chemotherapy (cisplatin is the drug of first choice) - been added. For cure, however, only a combination of radiotherapy and chemotherapy appears to be effective.

Key Words

carcinoma of the cervix - human papillomavirus (HPV) - screening - surgery - radiotherapy - chemotherapy

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2 karzinoembryonales Antigen

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