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 CancersWe offer screening to women at risk and this include 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).
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 SmearThe 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 a simple procedure where cells are collected from your cervix and sent to a laboratory for analysis. The test takes only a few minutes and can be done by a nurse or a doctor. It involves the taking of cell samples from the cervix done in the outpatient clinic setting. All sexually active women between age 25 to 65 are advised to have at least a 1- 3 yearly Pap smear.2. Human Papillomavirus (HPV) TestThe 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. An HPV test can be done using the same sample from the Pap test or by collecting a second sample from the cervical canal. Your doctor will gently insert an instrument called a speculum into your vagina. Then your doctor will take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. After your test, you can go about your normal daily activities without any restrictions.3. HPV VaccineHPV vaccination helps reduce the chances of getting cervical cancer. It works by preventing infection with specific types of HPV targeted by the vaccines. Specifically, HPV sub-types 16 & 18 cause about 70% cervical cancer cases, while HPV sub- types 6 & 11 cause about 90% genital warts cases. The maximum benefits of HPV vaccination occur when the vaccines are given before the start of sexual activity where HPV exposure occurs. The vaccines available are approved for use in females aged 9 to 26 years old (depending on the specific vaccine being administered) and Medisave claimable of up to SGD 400 for girls age 9 to 26.
- Cervical Cancer
Uterine/Endometrial cancer is a cancer that starts in the endometrium, the inner lining of the uterus (womb). Women with this cancer tend to show symptoms at an early stage, so they should report abnormal symptoms, such as any unexpected vaginal bleeding or spotting, to their doctors. There is no standard screening test. A vaginal ultrasound and biopsy of the inner lining of the uterus are commonly done for early detection of uterine cancer.
- Uterine/Endometrial Cancer
Ovarian cancer is a malignant tumor in one or both ovaries. Ovarian cancer is the fifth most common cancer in Singapore. Diagnosis is based on the physical examination of the pelvis and tests such as:
- Ovarian Cancer
- Ultrasound scan of the pelvis. The scan is either performed on the abdomen or via the vagina
- CA-125 is a tumor marker that is often raised in the blood of women with ovarian cancer
- CT scans of the abdomen and pelvis. This is useful in diagnosing ovarian cancer and studying the extent of the spread of cancer
- Biopsy is the removal of tissue for microscopic examination in order to make a diagnosis of the cancer. To obtain the tissue, a laparatomy (abdomen operation) is performed. If cancer is suspected, the entire ovary is removed (oophorectomy)
Cancer Surgery & Treatment
Surgical staging of cancers is performed in order to fully assess the extent of disease. This allows for decisions to be made regarding additional therapy, which is usually in the form of chemotherapy. Surgical staging generally involves removal of all visible disease, depending on the surgical findings thus offering patients the best chance of survival.
- Cancer Surgical Staging Procedures
For treatment of cancer, surgical expertise is critical to determining a women’s chances of survival. Dr Pang is a confident surgeon and has excellent results in management of cancers of the female reproductive tract. She has special interest in minimal access or key-hole surgery and is able to offer this approach when appropriate for treatment. Her training in advanced surgery and laparoscopy means that she is able to provide comprehensive surgical care for benign gynaecological conditions.Surgery can be done via conventional open method or the utilisation of minimally invasive technology e.g. laparoscopy and also state of the art technology Robotic surgery.
- Cancer Treatment Surgery
- Common Cancer Treatment Surgery include Radical hysterectomy (open/laparoscopic/robotic) for cervical cancer, staging hysterectomy procedures for ovarian and uterine cancer, vulva cancer surgery, debulking surgery and surgery for recurrent cancers e.g. pelvic exenteration
Management of Gynaeoncological Precancers of the cervix, vagina and vulva
We offer colposcopy screening of gynaecological precancers of the cervix, vagina and vulva. Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination. It is done using a colposcope, which provides an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them.
We also offer Loop Electrosurgical Excision Procedure (LEEP) for abnormal cervical cell changes. The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP can:
- Loop Electrosurgical Excision Procedure (LEEP)
Your doctor will insert a lubricated tool called a speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined. Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. During LEEP, only a small amount of normal tissue is removed at the edge of the abnormal tissue area. After LEEP, the tissue that is removed (specimen) can be examined for cancer that has grown deep into the cervical tissue (invasive cancer). In this way, LEEP can help further diagnosis as well as treat the abnormal cells. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future.
- Cut away abnormal cervical tissue that can be seen during colposcopy
- Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy