We provide a comprehensive workup for women suspected of having a gynaecological cancer. This includes a detailed history, physical examination, blood tests as well as diagnostic imaging.
Cancer of the cervix is the 10th most common cancer affecting women in Singapore today. They are mainly caused by the human papilloma virus (HPV) and women with these cancers present with abnormal vaginal bleeding such as postcoital bleeding. Treatment consists of surgery alone or combined with radiation therapy or chemotherapy. It is considered the most preventable cancer as there is an effective vaccine (HPV vaccine) against it as well as an effective screening tool such as the pap smear or HPV primary screening.
Cancer of the uterus is the 4th most common cancer affecting women in Singapore today. Most cancers arise from the lining of the uterus (endometrium) but sometimes, it can occur from the muscle of the uterus. Majority of women affected are above the age of 40 years. Most women present with the symptoms of abnormal uterine bleeding such as post-menopausal bleeding or abnormal menses. Risk factors for endometrial cancer include obesity, metabolic syndrome, type 2 diabetes, and a family history of the condition. Diagnosis of endometrial cancer is typically based on an endometrial biopsy. 60% of women are diagnosed in early stages hence the chance of cure with surgery alone is high.
Ovarian cancers are the 5th most common cancers affecting women of Singapore today. It also known as a silent killer as women are usually diagnosed in advanced stages. The symptoms are usually non-specific and patients may present with abdominal bloatedness, difficulty in eating, loss of appetite, etc and there is no effective methods to screen for it. Treatment usually involves a combination of surgery and chemotherapy as well as targeted therapy. Between 5-10% of ovarian cancers are hereditary. People with hereditary nonpolyposis colon cancer (Lynch syndrome), and those with BRCA-1 and BRCA-2 genetic abnormalities are at increased risk. The major genetic risk factor for ovarian cancer is a mutation in BRCA1 or BRCA2 genes, or in DNA mismatch repair genes, which is present in 10% of ovarian cancer cases.
Vulva and vaginal cancers are rare. Vulva cancers represent 5% of the total cancers involving the female genital tract. The development of vulva cancers may be due to the HPV virus or certain longstanding vulva conditions such as lichen sclerosis, VIN etc. Treatment involves surgery and radiation therapy. Sometimes, reconstructive skin surgery is required if the cancer is extensive.
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. There are several different types of GTD. Hydatidiform moles are benign in most cases, but sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma, which is likely to spread quickly. Fortunately, GTD are very sensitive to chemotherapy, and have a very good prognosis. GTD mainly affects women of child-bearing age but it may rarely occur in postmenopausal women.
The mainstay for treatment for gynaecological cancers is surgery followed by adjuvant treatment. Dr Timothy Lim has many years of experience in managing women with gynaecological cancers and is well versed in gynae cancer surgery.
Fertility sparing surgery may be performed in young women with early cervical and ovarian cancer cases. For early endometrial cancers, fertility sparing hormonal treatment is available. Please make an appointment to discuss further.
Minimally invasive surgery also known as laparoscopy or ‘keyhole surgery’ can be safely performed in women diagnosed with early cancers of the uterus and cervix.
Even after successful treatment for cancer, there is still a chance for cancer to relapse hence the importance of cancer surveillance. This will involve a combination of physical examination, blood tests as well as radiological imaging.