Women's Cancer Care

Risk Factors

The risk factors of ovarian cancer include:

• Late pregnancy
• Starting menstruation at an early age
• Late menopause
• Unexplained infertility
• Family history of cancer
• Genetic predisposition such as BRCA gene abnormalities or Lynch syndrome
• Endometriosis

Women who do not have any of the above risk factors may still get ovarian cancer. Talk to your gynaecologist to find out more.

Signs & Symptoms

Ovarian cancer in its early stages typically do not present any symptoms. In the more advanced stages, common symptoms include:

• Abdominal swelling or discomfort
• Bloating
• Persistent indigestion
• Nausea
• Changes in bowel habits such as constipation
• Loss of appetite
• Back pain

If you experience any of the above symptoms, consult a gynaecologist immediately. Early diagnosis is key to successful treatment and recovery. Talk to your gynaecologist to understand your risk of ovarian cancer and the tests that may be right for you.

Diagnosis

Your gynaecologist will check your medical history and perform a physical examination of the pelvic area. Further diagnostic tests may be prescribed for a complete assessment, such as:

• Blood tests, including tumour markers
• Ultrasound scan of the pelvis
• CT scan
• MRI scan
• PET-CT scan

Talk to your gynaecologist to understand more.

Treatment & Care

Treatment varies depending on the condition and its severity.

The mainstay of treatment in ovarian cancer is surgery. Advanced cases may require total removal of the uterus, ovaries, omentum (fat layer overlying the intestines) and lymph nodes. In certain cases, especially when the patient is young and wants to have children, conservative surgery is carried out. This involves removing only the affected ovary, preserving the uterus and other ovary for reproduction. To do this, the disease must be at an early stage with the cancer confined to just the ovary.

Chemotherapy may be needed after the operation. This depends on the type of ovarian cancer and the stage of disease.

Risk Factors

Common risk factors for uterine cancer include:

• Women above age 50 or who have undergone menopause
• Obesity
• Family history of cancer
• Diabetes
• Presence of ovarian tumors or syndromes such as polycystic ovarian syndrome

Women who do not have any of the above risk factors may still get uterine cancer. Talk to your gynaecologist to find out more.

Signs & Symptoms

Common uterine cancer symptoms include:

• Irregular vaginal bleeding
• Abnormal vaginal discharge, especially if blood stained
• Pressure or pain in pelvic area

If you experience any of the above symptoms, consult a gynaecologist immediately. Early diagnosis is key to successful treatment and recovery. Talk to your gynaecologist to understand your risk of uterine cancer and the tests that may be right for you.

Diagnosis

Your gynaecologist will check your medical history and perform a physical examination. The following diagnostic tests may be prescribed:

• Blood tests
• Ultrasound scan of the pelvis and the lining of the uterus (endometrium)
• CT scan
• MRI Scan
• Dilation and curettage (D&C)
• Hysteroscopy
• PET-CT scan

Talk to your gynaecologist to find out more.

Treatment & Care

With the proper diagnosis on the extent of uterine cancer, your gynaecologist will develop a comprehensive treatment plan that works for you. Depending on severity of the condition, surgery together with chemotherapy and radiation therapy may be required. Talk to your gynaecologist to understand more.

Risk Factors

Common risk factors for cervical cancer include:

• Having multiple sexual partners
• Early age of starting sexual intercourse
• Smoking
• History of severe cervical dysplasia, especially if untreated

Vaccines are effective against strains of HPV responsible for up to 85% of all cervical cancers. The most dangerous HPV subtypes are types 16 and 18, and the vaccines now available are effective against these 2 subtypes. Learn more about HPV vaccination.

Women still require regular pap smears even after having the HPV vaccination. Pap smears can detect pre-cancerous lesions of the cervix (cervical dysplasia), and when treated can pre-empt the development of cervical cancer.

Signs & Symptoms

Common symptoms of cervical cancer include:

• Irregular vaginal bleeding in between menstruation
• Abnormal vaginal discharge, especially if blood stained
• Bleeding after intercourse
• Pain in the lower back or pelvic area

If you experience any of the above symptoms, consult a gynaecologist immediately. Early diagnosis is key to successful treatment and recovery. Talk to your gynaecologist to understand your risk of cervical cancer and the tests that may be right for you.

Diagnosis

Your gynaecologist may look into your medical history and perform a pap smear. Further diagnostic test may be prescribed for an accurate diagnosis, such as:

• Biopsy
• Colposcopy
• Loop electrical excision procedure (LEEP)

Talk to your gynaecologist to understand more.

Treatment & Care

Depending on severity of the condition and any potential childbirth plans, your doctor will determine the treatment plan that works best for you. Treatment options include:

• Conservative surgery to preserve fertility in early stage 1 patients – radical trachelectomy and removal of lymph nodes
• Radical hysterectomy and removal of pelvic lymph nodes
• Radiation therapy
• Chemotherapy
• Concurrent radiotherapy and chemotherapy

Talk to your gynaecologist to find out more.

References:

Singapore Cancer Registry Interim Annual Report, Trends in Cancer Incidence in Singapore, 2010-2014, National Registry of Diseases Office (released 26 May 2015)

Risk Factors

Common risk factors for breast cancer include:

Non-modifiable risk factors

• Being a woman
• Increasing age
• Family history of cancer
• Early onset of menstruation (menarche) and/or late menopause
• Denser breast
• Proliferative breast conditions

Modifiable risk factors

• Having no children and lack of breastfeeding
• Being overweight
• Radiation exposure
• Alcohol or smoking
• Lack of physical therapy
• Long-term use of hormone replacement therapy or oral contraceptives

Regular screening such as annual mammograms is important to help detect breast cancer in its early stages. Early diagnosis improves survival outcomes and simplifies treatment plans. Talk to your doctor to find out more.

Signs & Symptoms

Common symptoms of breast cancer include:

• Painless lump in the breast
• Persistent itch or rash around the nipple
• Bleeding or unusual discharge from the nipple
• Skin over the breast is swollen or thickened
• Skin over the breast is dimpled or puckered
• Nipple becomes pulled in or retracted

It is recommended for women below age 40 to conduct a monthly breast self-examination to check for changes to the breast. For women aged 40 and above, it is recommended to go for a mammography at least once a year. Talk to your doctor to understand more.

Diagnosis

Your doctor will check your medical history and perform a clinical examination. The following diagnostic tests may be prescribed for a complete assessment:

• Mammogram
• Tomosynthesis (3D Mammography)
• Breast Ultrasound
• Magnetic resonance imaging (MRI)

If an abnormality is found during imaging, a biopsy may be required to confirm the diagnosis. This includes image-guided procedures such as:

• MRI-guided Core Needle / Vacuum-assisted Biopsy
• Stereotactic Core Needle / Vacuum-assisted Biopsy
• Ultrasound-guided Core Needle / Vacuum-assisted Biopsy
• Wire Localisation for Surgery (MRI, Stereotactic or Ultrasound-guided)

Treatment & Care

Treatment of breast cancer and chances of recovery depends on the subtype of the cancer as well as the stage and extent to which the cancer has spread. For most early breast cancers, surgical intervention is recommended to first remove the cancer from the body and to assess if the lymph nodes are involved.

In the past, traditional mastectomy (the removal of the whole breast) is performed. With advancements in surgical techniques, oncoplastic surgery or total reconstruction can now be safely performed to optimise the removal of cancer as well as restoration of the patient’s body image. Women no longer have to lose their breasts to breast cancer through mutilating surgeries.

For more advanced cases, chemotherapy with targeted treatments can now successfully downstage the cancers prior to surgery. Treatments like radiotherapy may also be required. Talk to your doctor to understand the treatment options available.

Emotional Support

Treatment of cancer may take a long time and the journey may be trying. It is important to obtain emotional support to help you through this difficult time.

CanHOPE is a non-profit cancer counselling and support service provider by Gleneagles Hospital. The CanHope team helps patients during their cancer treatment by providing counselling and education for them and their families. The team has dietitians who can recommend dietary plans for patients to stay healthy during treatment, and support group communities for patients to draw strength from each other. The staff at CanHOPE, experienced in working together with cancer patients and their families, aim to inspire hope and positivity to help patients cope with cancer. Find out more about CanHOPE support groups and programmes.