QUALITY OF LIFE - National Cancer Centre Singapore

PAGE B2
Looking Forward
SALUBRIS
September / October 2011
GYNAECOLOGICAL CANCERS:
TREATMENT AND SCREENING I
COPING WITH
UTERINE (WOMB) CANCER
PAGE B3
Tender Care
SALUBRIS
September / October 2011
Continued from page B1.
The uterus, or womb, is an important female reproductive
organ. The uterus is the pelvic organ that holds the baby during
pregnancy. Cancer of the womb (or uterine cancer) usually occurs
after menopause and it is now the 4th most common cancer
among women in Singapore. There are about 300 cases diagnosed
annually according to the Singapore Cancer Registry 2005-2009.
THE COMMON SYMPTOMS
OF CERVICAL CANCERS
ARE:
• Bleeding after intercourse
• Bleeding in between menses
• Blood stained or foul smelling
vaginal discharge
• Bleeding after menopause
• Pain is often a late sign of
cervical cancer
Cervical cancer presents as a growth on
the cervix and a biopsy will be taken by the
doctor to confirm the presence of cancerous
cells. Once the cancer is confirmed, the
patient will be referred to a gynaecologic
oncologist for further management,
which entails further investigations to
determine the extent/spread of the cancer.
This often entails imaging studies e.g.
CT scan, MRI and a procedure called
examination under anaesthesia.
For early cancers, the choice of treatment is between surgery and radiotherapy. The choice
will largely be dependent on factors e.g. age, surgical feasibility etc, which the oncologist
will advice accordingly depending on the individual patient. For advanced disease, the
treatment will be radiation concurrent with chemotherapy or chemotherapy.
FIVE-YEAR OUTLOOK
(SURVIVAL) IS
DEPENDENT ON STAGE:
• Stage 1 80-90%
• Stage 2 50-70%
• Stage 3 20-40%
• Stage 4 10-20%
The good news is that cervical cancer can be prevented. Concurrently, one can prevent
cervical cancer by HPV vaccination (primary prevention) and Pap smear (secondary
prevention). There are 2 vaccines available now: Cervarix and Gardasil. The latter covers
subtypes 16 and 18 i.e. the high risk subtypes that account for 70% of cervical cancers,
the latter besides covering subtypes 16 and 18 also covers low risk subtypes 6 and 11 that
causes genital warts. The vaccines are indicated for girls aged 9 to 26. Cervarix is available
at all polyclinics and is medisave deductible. Pap smear screening is recommended for all
sexually active women aged 25 to 65 at least once every three years. The Pap smear test
is a screening test for cervical cancer. It aims to detect precancer changes on the cervix
which can easily be treated so that cancer development can be prevented. It is a simple
and affordable test available at all polyclinics, GPs and Gynaecology Clinics.
As this is a cancer that affects mainly
women after menopause (75% of
cases), the most common presenting
symptom is postmenopausal bleeding (vaginal
bleeding after menopause). However, in
women who are still menstruating, it may
present with heavy irregular periods or
intermenstrual bleeding. There are several
known risk factors for this cancer including:
increasing age, late menopause, obesity, family
history of breast or womb cancer, personal
history of breast cancer, polycystic ovary
syndrome and estrogen only hormone therapy.
Treatment for womb cancer varies depending
on overall health and how advanced the
cancer is. Fortunately, most cancers of the
womb occur at an early stage and surgery
alone is curative. However, some patients
will require further treatment after surgery
if there is evidence of the cancer spreading.
This includes radiotherapy, chemotherapy or
hormonal therapy.
The stage of the cancer will determine
the type of treatment. The cancer is
referred to as early if it remains confined
to the region of the cervix. It is referred to
as advanced if it has spread beyond the
confines of the cervix to the surrounding
organs or distant organs.
By Dr Chia Yin Nin
MBBS(S’pore), MRCOG(UK), FAMS(S’pore), DGO(RANZCOG), GDipHCML(SMU)
Certified Gynaecologic Oncologist
Head & Consultant , Gynaecological Cancer Unit, KK Women’s and Children’s Hospital
Adjunct Assistant Professor, Duke’s Medical School, Singapore
Visiting Consultant, National Cancer Centre Singapore
Uterine cancer can be particularly difficult
to cope with, physically and emotionally.
Uterine cancer can be particularly difficult
to cope with, physically and emotionally. If
you have cancer, you may often feel tired. It is
important to learn ways to manage symptoms
of cancer and the side effects from cancer
treatment, and to maintain good nutrition and
overall well-being.
Continued on page B4.