Zervixkarzinom trotz Vorsorge

Abstract

Historical data, histological parameters and follow-up findings were reviewed both in 75 "prophylaxis failures" and in 255 cases of clinical cervical carcinoma treated surgically (Wertheim's procedure); all of these cases were diagnosed between 1974 and 1980. In 29.5% of the patients preventive care or respectively gynaecological examination failed. The many and varied causes of errors are discussed. Neither the histological tumour type, nor the lymph-node metastasis rate, nor the frequency of recurrence, nor the mortality figures are indicative of a more aggressive type of tumour in the "prophylaxis failures". Mortality among the latter is 13.3%, as opposed to 15.3% in the entire patient collective, the lymph-node metastasis rate 25.3% as compared to 31.8% overall, and the recurrence rate 18.1% as compared to 18.8% overall. As expected, cases with obviously delayed diagnosis have the highest mortality rate, i.e., 25% as against 15.3% overall. There is not a single case in which cancer can be shown to have developed without a preceding precancerous stage. It is suspected that mistakes made while obtaining smears are the principal cause of failure of prophylaxis, followed by errors of evaluation, in histology, and in therapeutic measures taken after histological confirmation of cervical neoplasm. These results do not in any way exclude an aggressive type of tumour in rare individual cases; however, the occurrence of such a tumour would be an exception.