Gynaecological cancers originate from a woman’s reproductive organs. Today, they have become a serious concern. Gynaecological cancer rankings paint a stark but realistic picture.* Geared towards the gentler sex, our team is on hand to offer advice, medical and surgical care in the fight against gynaecological cancers.
*Singapore Cancer Registry, Interim Annual Registry Report, Trends in Cancer Incidence in Singapore, 2009-2013
Screening & Management of Gynaecological Cancers
We offer screening to women at risk and this includes ultrasound scan surveillance, biopsy procedure and tumor markers tests as well as predictive gene tests to check for cancer risks. The predictive genetic test is used to look for gene mutations that might put a person at risk of getting a certain cancer (or cancers). It is usually done in a person with a suspected family gene mutation known to increase the risk for a certain cancer (or cancers).
Cervical Cancer
Cancer of the cervix is the most common cancer of the woman’s reproductive system. Yet it is the most accessible of the female reproductive system. The accessibility of the cervix allows the wide use of the Papanicolaou (Pap) smear as a reliable and economical screening test for cancer of the cervix.
1. Pap Smear
The Papanicolaou test (abbreviated as Pap test, known earlier as Pap smear, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the endocervical canal. It is performed by opening the vagina with a speculum, collecting cells at the outer opening of the cervix, and examining them under a microscope.
All sexually active women between age 25 to 65 are advised to have at least a 1–3 yearly Pap smear. The procedure takes only a few minutes and can be performed by nurses or doctors in an outpatient setting. Cervical cancers picked up at the pre-cancerous stage are highly treatable.
2. Human Papillomavirus (HPV) Test
The HPV test detects the presence of human papillomavirus, a virus that can lead to the development of genital warts, abnormal cervical cells or cervical cancer. The sample for the HPV test can be collected at the same time as the Pap smear, or as a separate cervical sample using a speculum, soft brush and spatula. Normal activities can resume immediately after testing.
3. HPV Vaccine
HPV vaccination helps reduce the chances of developing cervical cancer by preventing infection with the targeted HPV sub-types. HPV sub-types 16 & 18 cause about 70% of cervical cancer cases, while HPV sub-types 6 & 11 cause about 90% of genital wart cases. Maximum benefit from the vaccine is gained when given before the start of sexual activity.
The HPV vaccine is approved for use in females aged 9 to 26 years old, and Medisave coverage of up to SGD 400 is available in Singapore.
4. Colposcopy and LEEP
Colposcopy is the close inspection of the cervix used after an abnormal Pap smear. LEEP (loop electrosurgical excision procedure) is a treatment for pre-cancerous lesions — see the dedicated section below for full details.
5. Hysteroscopy & Endometrial Biopsy
Direct visualisation and sampling of the uterine cavity to evaluate abnormal bleeding or suspected endometrial cancer.
Uterine / Endometrial Cancer
Uterine or endometrial cancer begins in the endometrium, the inner lining of the uterus. Women often show early symptoms such as unexpected vaginal bleeding or spotting that should be reported to a doctor. There is no standard screening test, though vaginal ultrasound and uterine lining biopsy commonly aid early detection.
Ovarian Cancer
Ovarian cancer is a malignant tumour in one or both ovaries and is the fifth most common cancer in Singapore. Diagnosis relies on pelvic examination and the following tests:
- Ultrasound scan of the pelvis (abdominal or vaginal approach)
- CA-125 tumour marker blood test, often elevated in ovarian cancer
- CT scans of the abdomen and pelvis to diagnose and assess disease spread
- Biopsy via laparotomy (abdominal surgery) to examine tissue microscopically; entire ovary removal (oophorectomy) is performed if cancer is suspected
Cancer Surgery & Treatment
Cancer Surgical Staging Procedures. Surgical staging fully assesses disease extent, informing decisions about additional therapy, typically chemotherapy. Staging generally involves removal of all visible disease, offering patients improved survival chances.
Cancer Treatment Surgery. Surgical expertise critically impacts women’s cancer survival outcomes. Dr Pang specialises in minimal-access (“key-hole”) surgery and advanced laparoscopy. Surgery methods include conventional open procedures, minimally invasive laparoscopy, and robotic surgery.
Common cancer treatment surgeries include radical hysterectomy (open / laparoscopic / robotic) for cervical cancer, staging hysterectomy for ovarian and uterine cancer, vulva cancer surgery, debulking surgery, and surgery for recurrent cancers including pelvic exenteration.
Management of Gynaeoncological Precancers of the Cervix, Vagina and Vulva
Colposcopy. Colposcopy examines an illuminated, magnified view of the cervix and vaginal/vulval tissue using a colposcope. The procedure detects pre-malignant and malignant lesions, allowing visual distinction between normal and abnormal tissue. Directed biopsies enable pathological examination. The main goal of colposcopy is to prevent cervical cancer by detecting pre-cancerous lesions early and treating them.
Loop Electrosurgical Excision Procedure (LEEP). LEEP uses a thin, low-voltage electrified wire loop to excise abnormal tissue after abnormal Pap results are confirmed by colposcopy and biopsy. LEEP can:
- Cut away abnormal cervical tissue visible during colposcopy
- Remove abnormal tissue high in the cervical canal not visible during colposcopy
A speculum gently spreads the vaginal walls for examination. Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Removed tissue undergoes examination for invasive cancer, aiding both diagnosis and treatment. If abnormal tissue is completely removed, additional surgery may not be necessary, though cell abnormalities may recur and follow-up is important.