Skip to main content
Erschienen in: Die Gynäkologie 11/2023

09.10.2023 | Konisation | Leitthema

Schwangerschaft und Zervixkarzinom – welche Möglichkeiten gibt es?

verfasst von: Carl Mathis Wild, Prof. Dr. Christian Dannecker

Erschienen in: Die Gynäkologie | Ausgabe 11/2023

Einloggen, um Zugang zu erhalten

Zusammenfassung

Zervixkarzinome sind die häufigste gynäkologische Krebserkrankung in der Schwangerschaft und werden meist im Frühstadium diagnostiziert. Nach histologischer Sicherung muss das weitere Vorgehen interdisziplinär mit der Patientin diskutiert werden. Die endgültige Therapie ist unabhängig von der Schwangerschaft und richtet sich nach dem Tumorstadium. In fortgeschrittenen Tumorstadien sollten eine zeitnahe Entbindung und Einleitung der definitiven Therapie in Erwägung gezogen werden. Falls die Patientin den Erhalt der Schwangerschaft wünscht, kommen im Frühstadium fertilitätserhaltende Operationen oder bei höheren Tumorstadien eine neoadjuvante Chemotherapie in Betracht. Die Entbindung sollte per Sectio caesarea erfolgen. Im Beitrag werden die Therapieoptionen in der Schwangerschaft dargestellt.
Literatur
1.
Zurück zum Zitat Alouini S, Rida K, Mathevet P (2008) Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 108:472–477PubMed Alouini S, Rida K, Mathevet P (2008) Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 108:472–477PubMed
2.
Zurück zum Zitat Amant F, Halaska MJ, Fumagalli M et al (2014) Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer 24:394–403PubMed Amant F, Halaska MJ, Fumagalli M et al (2014) Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer 24:394–403PubMed
3.
Zurück zum Zitat Amant F, Vandenbroucke T, Verheecke M et al (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med 373:1824–1834PubMed Amant F, Vandenbroucke T, Verheecke M et al (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med 373:1824–1834PubMed
4.
Zurück zum Zitat Averette HE, Nasser N, Yankow SL et al (1970) Cervical conization in pregnancy. Analysis of 180 operations. Am J Obstet Gynecol 106:543–549PubMed Averette HE, Nasser N, Yankow SL et al (1970) Cervical conization in pregnancy. Analysis of 180 operations. Am J Obstet Gynecol 106:543–549PubMed
5.
Zurück zum Zitat Bentivegna E, Maulard A, Pautier P et al (2016) Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 106:1195–1211.e1195PubMed Bentivegna E, Maulard A, Pautier P et al (2016) Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 106:1195–1211.e1195PubMed
6.
Zurück zum Zitat Cardonick E, Bhat A, Gilmandyar D et al (2012) Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol 23:3016–3023PubMed Cardonick E, Bhat A, Gilmandyar D et al (2012) Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol 23:3016–3023PubMed
7.
Zurück zum Zitat Cardonick EH, Gringlas MB, Hunter K et al (2015) Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol 212:658.e651–658.e658 Cardonick EH, Gringlas MB, Hunter K et al (2015) Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol 212:658.e651–658.e658
8.
Zurück zum Zitat Cordeiro CN, Gemignani ML (2017) Gynecologic malignancies in pregnancy: balancing fetal risks with oncologic safety. Obstet Gynecol Surv 72:184–193PubMedPubMedCentral Cordeiro CN, Gemignani ML (2017) Gynecologic malignancies in pregnancy: balancing fetal risks with oncologic safety. Obstet Gynecol Surv 72:184–193PubMedPubMedCentral
9.
Zurück zum Zitat Covens A, Rosen B, Murphy J et al (2002) How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 84:145–149PubMed Covens A, Rosen B, Murphy J et al (2002) How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 84:145–149PubMed
10.
Zurück zum Zitat De Vincenzo R, Tortorella L, Ricci C et al (2018) Locally advanced cervical cancer complicating pregnancy: a case of competing risks from the catholic university of the sacred heart in Rome. Gynecol Oncol 150:398–405PubMed De Vincenzo R, Tortorella L, Ricci C et al (2018) Locally advanced cervical cancer complicating pregnancy: a case of competing risks from the catholic university of the sacred heart in Rome. Gynecol Oncol 150:398–405PubMed
11.
Zurück zum Zitat Demeter A, Sziller I, Csapó Z et al (2002) Outcome of pregnancies after cold-knife conization of the uterine cervix during pregnancy. Eur J Gynaecol Oncol 23:207–210PubMed Demeter A, Sziller I, Csapó Z et al (2002) Outcome of pregnancies after cold-knife conization of the uterine cervix during pregnancy. Eur J Gynaecol Oncol 23:207–210PubMed
12.
Zurück zum Zitat Deutsche Gesellschaft füR GynäKologie und Geburtshilfe E. V. (Dggg) AGKOEVA (2022) Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 2.2, 2022, AWMF-Registernummer: 032/033OL Deutsche Gesellschaft füR GynäKologie und Geburtshilfe E. V. (Dggg) AGKOEVA (2022) Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 2.2, 2022, AWMF-Registernummer: 032/033OL
13.
Zurück zum Zitat Douligeris A, Prodromidou A, Psomiadou V et al (2020) Abdominal radical trachelectomy during pregnancy: a systematic review of the literature. J Gynecol Obstet Hum Reprod 49:101607PubMed Douligeris A, Prodromidou A, Psomiadou V et al (2020) Abdominal radical trachelectomy during pregnancy: a systematic review of the literature. J Gynecol Obstet Hum Reprod 49:101607PubMed
14.
Zurück zum Zitat Douvier S, Filipuzzi L, Sagot P (2003) Management of cervical intra-epithelial neoplasm during pregnancy. Gynecol Obstet Fertil 31:851–855PubMed Douvier S, Filipuzzi L, Sagot P (2003) Management of cervical intra-epithelial neoplasm during pregnancy. Gynecol Obstet Fertil 31:851–855PubMed
15.
Zurück zum Zitat Duggan B, Muderspach LI, Roman LD et al (1993) Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 82:598–602PubMed Duggan B, Muderspach LI, Roman LD et al (1993) Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 82:598–602PubMed
16.
Zurück zum Zitat Erdmann F, Spix C, Katalinic A et al (2021) Krebs in Deutschland für 2017/2018. Robert Koch-Institut, Berlin, S 172 Erdmann F, Spix C, Katalinic A et al (2021) Krebs in Deutschland für 2017/2018. Robert Koch-Institut, Berlin, S 172
17.
Zurück zum Zitat Esposito S, Tenconi R, Preti V et al (2016) Chemotherapy against cancer during pregnancy: A systematic review on neonatal outcomes. Medicine 95:e4899PubMedPubMedCentral Esposito S, Tenconi R, Preti V et al (2016) Chemotherapy against cancer during pregnancy: A systematic review on neonatal outcomes. Medicine 95:e4899PubMedPubMedCentral
18.
Zurück zum Zitat Fader AN, Alward EK, Niederhauser A et al (2010) Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol 203:113.e111–113.e116 Fader AN, Alward EK, Niederhauser A et al (2010) Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol 203:113.e111–113.e116
19.
Zurück zum Zitat Germann N, Haie-Meder C, Morice P et al (2005) Management and clinical outcomes of pregnant patients with invasive cervical cancer. Ann Oncol 16:397–402PubMed Germann N, Haie-Meder C, Morice P et al (2005) Management and clinical outcomes of pregnant patients with invasive cervical cancer. Ann Oncol 16:397–402PubMed
20.
Zurück zum Zitat Gonçalves CV, Duarte G, Costa JS et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J 127:359–365PubMed Gonçalves CV, Duarte G, Costa JS et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J 127:359–365PubMed
21.
Zurück zum Zitat Han SN, Mhallem Gziri M, Van Calsteren K et al (2013) Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies. Ther Adv Med Oncol 5:211–219PubMedPubMedCentral Han SN, Mhallem Gziri M, Van Calsteren K et al (2013) Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies. Ther Adv Med Oncol 5:211–219PubMedPubMedCentral
22.
Zurück zum Zitat Hopkins MP, Morley GW (1992) The prognosis and management of cervical cancer associated with pregnancy. Obstet Gynecol 80:9–13PubMed Hopkins MP, Morley GW (1992) The prognosis and management of cervical cancer associated with pregnancy. Obstet Gynecol 80:9–13PubMed
23.
Zurück zum Zitat Köhler C, Oppelt P, Favero G et al (2015) How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy. Am J Obstet Gynecol 213:206.e201–206.e205 Köhler C, Oppelt P, Favero G et al (2015) How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy. Am J Obstet Gynecol 213:206.e201–206.e205
24.
Zurück zum Zitat Kyrgiou M, Athanasiou A, Paraskevaidi M et al (2016) Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 354:i3633PubMedPubMedCentral Kyrgiou M, Athanasiou A, Paraskevaidi M et al (2016) Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 354:i3633PubMedPubMedCentral
25.
Zurück zum Zitat Muller CY, Smith HO (2005) Cervical neoplasia complicating pregnancy. Obstet Gynecol Clin North Am 32:533–546PubMed Muller CY, Smith HO (2005) Cervical neoplasia complicating pregnancy. Obstet Gynecol Clin North Am 32:533–546PubMed
26.
Zurück zum Zitat Nguyen C, Montz FJ, Bristow RE (2000) Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 55:633–643PubMed Nguyen C, Montz FJ, Bristow RE (2000) Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 55:633–643PubMed
27.
Zurück zum Zitat Papadia A, Mohr S, Imboden S et al (2016) Laparoscopic Indocyanine green sentinel lymph node mapping in pregnant cervical cancer patients. J Minim Invasive Gynecol 23:270–273PubMed Papadia A, Mohr S, Imboden S et al (2016) Laparoscopic Indocyanine green sentinel lymph node mapping in pregnant cervical cancer patients. J Minim Invasive Gynecol 23:270–273PubMed
28.
Zurück zum Zitat Plante M, Kwon JS, Ferguson S et al (2023) An international randomized phase III trial comparing radical hysterectomy and pelvic node dissection (RH) vs simple hysterectomy and pelvic node dissection (SH) in patients with low-risk early-stage cervical cancer (LRESCC): A Gynecologic Cancer Intergroup study led by the Canadian Cancer Trials Group (CCTG CX.5-SHAPE). J Clin Oncol 41:LBA5511 Plante M, Kwon JS, Ferguson S et al (2023) An international randomized phase III trial comparing radical hysterectomy and pelvic node dissection (RH) vs simple hysterectomy and pelvic node dissection (SH) in patients with low-risk early-stage cervical cancer (LRESCC): A Gynecologic Cancer Intergroup study led by the Canadian Cancer Trials Group (CCTG CX.5-SHAPE). J Clin Oncol 41:LBA5511
29.
Zurück zum Zitat Plante M, Renaud MC, François H et al (2004) Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. Gynecol Oncol 94:614–623PubMed Plante M, Renaud MC, François H et al (2004) Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. Gynecol Oncol 94:614–623PubMed
30.
Zurück zum Zitat Plante M, Renaud MC, Sebastianelli A et al (2020) Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care? Int J Gynecol Cancer 30:981–986PubMed Plante M, Renaud MC, Sebastianelli A et al (2020) Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care? Int J Gynecol Cancer 30:981–986PubMed
31.
Zurück zum Zitat Robinson WR, Webb S, Tirpack J et al (1997) Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol 64:153–155PubMed Robinson WR, Webb S, Tirpack J et al (1997) Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol 64:153–155PubMed
33.
Zurück zum Zitat Shim SH, Lim MC, Kim HJ et al (2018) Can simple trachelectomy or conization show comparable survival rate compared with radical trachelectomy in IA1 cervical cancer patients with lymphovascular space invasion who wish to save fertility? A systematic review and guideline recommendation. PLoS ONE 13:e189847PubMedPubMedCentral Shim SH, Lim MC, Kim HJ et al (2018) Can simple trachelectomy or conization show comparable survival rate compared with radical trachelectomy in IA1 cervical cancer patients with lymphovascular space invasion who wish to save fertility? A systematic review and guideline recommendation. PLoS ONE 13:e189847PubMedPubMedCentral
34.
Zurück zum Zitat Shinkai S, Ishioka S, Mariya T et al (2022) Does radical trachelectomy (RT) during pregnancy have higher obstetrical and oncological risks than RT before pregnancy? Arch Gynecol Obstet 306:189–197PubMed Shinkai S, Ishioka S, Mariya T et al (2022) Does radical trachelectomy (RT) during pregnancy have higher obstetrical and oncological risks than RT before pregnancy? Arch Gynecol Obstet 306:189–197PubMed
35.
Zurück zum Zitat Smith LH, Dalrymple JL, Leiserowitz GS et al (2001) Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 184:1504–1512 (discussion 1512–1503)PubMed Smith LH, Dalrymple JL, Leiserowitz GS et al (2001) Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 184:1504–1512 (discussion 1512–1503)PubMed
36.
Zurück zum Zitat Smith LH, Danielsen B, Allen ME et al (2003) Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 189:1128–1135PubMed Smith LH, Danielsen B, Allen ME et al (2003) Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 189:1128–1135PubMed
37.
Zurück zum Zitat Song Y, Liu Y, Lin M et al (2019) Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis. Drug Des Devel Ther 13:79–102PubMed Song Y, Liu Y, Lin M et al (2019) Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis. Drug Des Devel Ther 13:79–102PubMed
38.
Zurück zum Zitat Sorosky JI, Squatrito R, Ndubisi BU et al (1995) Stage I squamous cell cervical carcinoma in pregnancy: planned delay in therapy awaiting fetal maturity. Gynecol Oncol 59:207–210PubMed Sorosky JI, Squatrito R, Ndubisi BU et al (1995) Stage I squamous cell cervical carcinoma in pregnancy: planned delay in therapy awaiting fetal maturity. Gynecol Oncol 59:207–210PubMed
39.
Zurück zum Zitat Stan C, Megevand E, Irion O et al (2005) Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment. Eur J Gynaecol Oncol 26:649–650PubMed Stan C, Megevand E, Irion O et al (2005) Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment. Eur J Gynaecol Oncol 26:649–650PubMed
40.
Zurück zum Zitat Takushi M, Moromizato H, Sakumoto K et al (2002) Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol 87:185–189PubMed Takushi M, Moromizato H, Sakumoto K et al (2002) Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol 87:185–189PubMed
41.
Zurück zum Zitat Van Calsteren K, Vergote I, Amant F (2005) Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 19:611–630PubMed Van Calsteren K, Vergote I, Amant F (2005) Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 19:611–630PubMed
42.
Zurück zum Zitat Van Den Broek NR, Lopes AD, Ansink A et al (1995) “Microinvasive” adenocarcinoma of the cervix implanting in an episiotomy scar. Gynecol Oncol 59:297–299PubMed Van Den Broek NR, Lopes AD, Ansink A et al (1995) “Microinvasive” adenocarcinoma of the cervix implanting in an episiotomy scar. Gynecol Oncol 59:297–299PubMed
43.
Zurück zum Zitat Vandenbroucke T, Verheecke M, Fumagalli M et al (2017) Effects of cancer treatment during pregnancy on fetal and child development. Lancet Child Adolesc Health 1:302–310PubMed Vandenbroucke T, Verheecke M, Fumagalli M et al (2017) Effects of cancer treatment during pregnancy on fetal and child development. Lancet Child Adolesc Health 1:302–310PubMed
44.
Zurück zum Zitat Vercellino GF, Koehler C, Erdemoglu E et al (2014) Laparoscopic pelvic lymphadenectomy in 32 pregnant patients with cervical cancer: rationale, description of the technique, and outcome. Int J Gynecol Cancer 24:364–371PubMed Vercellino GF, Koehler C, Erdemoglu E et al (2014) Laparoscopic pelvic lymphadenectomy in 32 pregnant patients with cervical cancer: rationale, description of the technique, and outcome. Int J Gynecol Cancer 24:364–371PubMed
45.
Zurück zum Zitat Wright JD, Grigsby PW, Brooks R et al (2007) Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy. Cancer 110:1281–1286PubMed Wright JD, Grigsby PW, Brooks R et al (2007) Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy. Cancer 110:1281–1286PubMed
46.
Zurück zum Zitat Yoneda JY, Braganca JF, Sarian LO et al (2015) Surgical treatment of microinvasive cervical cancer: analysis of pathologic features with implications on radicality. Int J Gynecol Cancer 25:694–698PubMed Yoneda JY, Braganca JF, Sarian LO et al (2015) Surgical treatment of microinvasive cervical cancer: analysis of pathologic features with implications on radicality. Int J Gynecol Cancer 25:694–698PubMed
47.
Zurück zum Zitat Zagouri F, Sergentanis TN, Chrysikos D et al (2013) Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta-analysis. Obstet Gynecol 121:337–343PubMed Zagouri F, Sergentanis TN, Chrysikos D et al (2013) Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta-analysis. Obstet Gynecol 121:337–343PubMed
48.
Zurück zum Zitat Zhang Q, Li W, Kanis MJ et al (2017) Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 8:46580–46592PubMedPubMedCentral Zhang Q, Li W, Kanis MJ et al (2017) Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 8:46580–46592PubMedPubMedCentral
Metadaten
Titel
Schwangerschaft und Zervixkarzinom – welche Möglichkeiten gibt es?
verfasst von
Carl Mathis Wild
Prof. Dr. Christian Dannecker
Publikationsdatum
09.10.2023
Verlag
Springer Medizin
Erschienen in
Die Gynäkologie / Ausgabe 11/2023
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-023-05148-z

Weitere Artikel der Ausgabe 11/2023

Die Gynäkologie 11/2023 Zur Ausgabe

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Harninkontinenz: Netz-Op. erfordert über lange Zeit intensive Nachsorge

30.04.2024 Harninkontinenz Nachrichten

Frauen mit Belastungsinkontinenz oder Organprolaps sind nach einer Netz-Operation keineswegs beschwerdefrei. Vielmehr scheint die Krankheitslast weiterhin hoch zu sein, sogar höher als von harninkontinenten Frauen, die sich nicht haben operieren lassen.

Welche Übungen helfen gegen Diastase recti abdominis?

30.04.2024 Schwangerenvorsorge Nachrichten

Die Autorinnen und Autoren einer aktuellen Studie aus Griechenland sind sich einig, dass Bewegungstherapie, einschließlich Übungen zur Stärkung der Bauchmuskulatur und zur Stabilisierung des Rumpfes, eine Diastase recti abdominis postpartum wirksam reduzieren kann. Doch vieles ist noch nicht eindeutig belegt.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.