People often assume that cancer is a death sentence and that there is no way of preventing the disease. Or they may believe that if they do not have any symptoms, they do not have cancer. However, the early diagnosis of cancers can save lives and treatment is often simpler and more likely to be effective. We wish to educate women with the early signs of cancer and the available treatment options for them to make the critical decisions for themselves and their loved ones.
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Cancer occurs when old cells do not die when they should or are damaged. Normally, the body repairs or destroys such cells. Sometimes, these cells may grow out of control. This causes growths or tumors to form. Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other parts of the body. Malignant tumors can invade and destroy healthy tissues and organs. Cancer cells can also spread to other parts of the body and form new tumors. The risk of cancer can be inherited in a person’s genes. In some cases, cancer can be caused by being exposed to a harmful substance such as a virus, certain chemicals, or radiation. Sometimes more than one cause is involved.
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Gynecological cancers including 5 main cancers occurring in the female reproductive system: cervical, ovarian, uterine, vaginal, and vulvar are most likely to occur in women. Today, they have become a serious concern. *Uterine (womb) cancer is now the fourth most common cancer among Singaporean women (it held eight position a decade ago). Ovarian cancer is the fifth and cervical cancer is the tenth most common cancers respectively. These rankings paint a stark but realistic picture.
*Singapore Cancer Registry, Interim Annual Registry Report, Trends in Cancer Incidence in Singapore, 2009 – 2013
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Cervical Cancer
Virtually all cervical cancers are caused by human papilloma virus (HPV) infection. HPV may cause a spectrum of precancerous changes known as cervical intraepthelial neoplasia (CIN) and a small proportion of these will develop into invasive cervical cancer. This process, from HPV infection to invasive cervical cancer, usually takes at least 10-15 years.
Factors that increase the likelihood of cervical cancer include:
- Having several children
- Multiple sexual partners
- Smoking
- Long-term use of oral contraceptives
- Other infections including herpes and chlamydia
- HIV and immunosuppression such as following transplantation
Ovarian Cancer
Most ovarian cancers develop after the menopause. Apart from age, factors that may increase a woman’s risk include:
- Early onset of periods and late menopause
- Having no or few children
- Long-term use of hormone replacement therapy (though the oral contraceptive pill may reduce risk)
- Endometriosis or ovarian cysts are associated with an increased risk of ovarian cancer
- Obesity
- Diet high in saturated fat
- Smoking
- Previous breast cancer
- Mother or sister with ovarian cancer
- BRCA genes
Uterine Cancer
The cause of uterine cancer remains unclear, but several factors other than age are known to increase the risk:
- Greater exposure to the female hormone oestrogen; for example, through early onset of periods, late menopause
- Obesity, probably because obesity raises oestrogen levels
- Diabetes and polycystic ovary syndrome, possibly because resistance to the effects of insulin can stimulate growth of cancer cells
- Other cancers, such as breast, colon or rectum
- Mother or sister with endometrial cancer
- Lynch syndrome (Inherited cancers)
- Long-term treatment with tamoxifen (given to prevent breast cancer recurrence)
- Possibly a diet high in meat
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Who should go for cancer screening?
It is best to get yourself screened if you have a family member who has been diagnosed with some form of cancer. Your doctor will recommend the type of screening tests and frequency. If the results are abnormal, you may need more specific diagnostic tests to confirm if you have cancer.
Ovarian Cancer
A cancer of the ovaries in a woman. Early ovarian cancer may not cause any obvious symptoms and may go undetected.
Screening
Annual pelvic examination and vaginal ultrasound, with or without blood test for tumour marker (CA 125), is recommended for women who are at high risk of ovarian cancer.
Should you be screened for ovarian cancer?
A genetic risk assessment and yearly screening are recommended if you are at increased risk, i.e. you have two or more first-degree relatives (mother, sister or daughter) with ovarian cancer.
Consult your doctor if you experience any suspicious persistent symptoms, such as:
- Abdominal bloating
- Abdominal or pelvic pain
- Constipation
- Urinary problems
- Unexplained weight loss
- Cervical Cancer
Cervical Cancer
A genetic risk assessment and yearly screening are recommended if you are at increased risk, i.e. you have two or more first-degree relatives (mother, sister or daughter) with ovarian cancer.
If you’ve never had sexual intercourse, you do not need a Pap smear test. But if you experience abnormal vaginal discharge, you should consult your doctor.
If you are between 25 and 69 years and have ever had sexual intercourse, you should go for a Pap smear once every three years. You can stop taking the test at 69 if your Pap smear taken at 69 and in the past have been clear.
If you are HIV positive, you should go for a Pap smear test every year.
Even if you have had HPV vaccination, you should go for regular Pap smear screening once every three years.
Once cancer has developed, the most common symptom is abnormal vaginal bleeding:
- Bleeding between periods or after sex before the menopause
- Bleeding at any time after the menopause
Other symptoms include:
- Vaginal discharge that smells unpleasant
- Discomfort or pain during sex
Tests to confirm the diagnosis include:
- Internal pelvic examination to check the cervix
- Colposcopy
- Biopsy of the cervix
- Scans to confirm how far the cancer has spread
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Two vaccines are available to prevent the human papillomavirus (HPV) types 16 and 18 that cause most cervical cancers.
These vaccines are bivalent vaccine and quadrivalent. The quadrivalent vaccine is licensed also for boys as well as prevention of genital warts caused by HPV 6 and 11 subtypes.Just like how other vaccines are given to PREVENT infection, the HPV vaccine should be given before the patient has exposure to the virus (i.e. before she becomes sexually active). The protection for women against HPV 16/18 related precancer/ cancer is more than 95% if given before sexual debut, making this one of the most effective vaccines available.
Both vaccines involve having 3 doses given to the upper arm. The best age for vaccination is 11- 12 years old.
The doctor will give you advice and answer your questions on which to consider for you or your child for primary prevention of cervical cancer.