With approximately 800 diagnoses per year, cervical cancer is relatively rare. Survival has increased in recent decades, except in women who were 75 years of age or older at the time of diagnosis. That is the conclusion of Hans Wenzel, who will receive his PhD on 3 June. His dissertation consists of various studies on optimizing the quality of care based on (inter)national data.
Key figures cervical cancer
All key figures (epidemiology, survival and treatment) are in the online report’Cervical cancer in the Netherlands‘ lined up. The page provides an overview in national figures, but also shows the variation between different regions and was made on the occasion of Hans Wenzel’s promotion.
In contrast to the relatively low number of diagnoses in the Netherlands, cervical cancer is more common worldwide and is the fourth most common cancer. If the disease is detected at an early stage, and the tumor is limited to the cervix, uterus or the upper part of the vagina, the chances of survival are greatest.
Open vs Laparoscopic Treatment
When diagnosed at an early stage, radical hysterectomy (surgical removal of the uterus and surrounding tissue) is the main treatment. This treatment can be performed with keyhole surgery (laparoscopic) or open abdominal surgery. Contrary to expectations, international research showed that laparoscopic treatment resulted in a poorer chance of survival. Wenzel and colleagues looked at data from the Dutch Cancer Registry of women who underwent this treatment in the Netherlands. They saw that in the Netherlands it does not matter in terms of survival and recurrence of disease whether an open abdominal operation or keyhole surgery is chosen. A renewed analysis in which the patients were followed for an even longer period also confirms this fact.
Also read: Early cervical cancer survival equal by surgical approach
Survival of older patient not improved
In his dissertation, Wenzel also pays attention to the survival of cervical cancer. Based on data from 21,000 patients, he and colleagues examined whether the outcome of cervical cancer treatment has improved over the past three decades. The five-year survival rate was 74 percent in 2018 and 68 percent in 1989. Wenzel: ‘In general, an improvement can be seen, but this is not the case in women who are 75 years or older at the time of diagnosis. That is of course distressing to see. It is possible that these women can be helped better in the future with less invasive treatment.’
Also read: Survival cervical cancer elderly patient lags behind
Evaluation of treatment of lymph node metastases
In surgical treatment of stage I tumors, lymph nodes may also be removed, as there is a risk of lymph node metastases. In 2018, the criteria for stage I tumors changed, so that a specific subgroup of stage IB tumors are now classified as stage IA. Wenzel and colleagues wanted to investigate the risk of metastasis in the pelvic nodes in this patient group, so that they may be able to do with less invasive treatment of the lymph nodes. They concluded that the chance of metastasis appears to be related to whether there is vascular invasion, how deep the tumor has penetrated healthy tissue and the type of cells from which the cancer originated.
Also read: Evaluation of lymph nodes in microinvasive cervical cancer
- Hans Wenzel will receive his doctorate from the University of Groningen on 3 June. His supervisors are Prof. Dr. Hans Nijman, Prof. Dr. Ruud Bekkers, Prof. Dr. Valery Lemmens. His co-supervisor is Dr. Maaike van der Aa. The dissertation entitled ‘Improving quality of cervical cancer care with (inter)national cancer registry data’ can be consulted here.