Cancer research and medical advances are moving at a very rapid pace, and we are now able to treat cancers with new advancements in science and technology.

Cancers that affect the female reproductive tract include cancers of the cervix, ovary, uterus, vulva and vagina.

Healthy eating and living, vitamin supplementation, exercise, and avoiding harmful, cancer-causing agents go a long way to preventing cancer. Equally important are regular health-screening checks to detect any disease early so that it can be treated quickly and effectively for better prognosis.

1. Cervical Cancer

Cancer of the cervix begins in the lining of the cervix. It is caused by several subtypes of the human papilloma virus (HPV). Today, cancer of the cervix should be detected early with the availability of the HPV vaccine, pap smear screening and appropriate surgery and radiotherapy.

Common symptoms in cervical cancer include bleeding after intercourse, vaginal discharge and pelvic pain that is not related to the normal menstrual cycle.

A detailed clinical examination, pap smears and colposcopy can all help in the evaluation of the cervix and diagnosis/exclusion of cervical cancer. Occasionally a biopsy may be necessary. 

In cases of cervical cancer, a detailed staging of the disease is necessary. This includes examinations under anaesthesia, biopsies, a cystoscopy, CT scanning and an MRI.

Early stage disease can be managed with local excision, but more advanced disease may require a hysterectomy and even radiotherapy. A special type of surgery, a Wertheim radical hysterectomy, is an extended hysterectomy with ovarian function preservation. Prognosis after this surgery is usually good, but regular clinical follow up is essential.

2. Ovarian Cancer

Ovarian cancer is now the most common gynaecological cancer in Singapore. It is the most lethal of all gynaecological malignancies. This is because it remains silent within the woman’s abdomen until a late stage of disease. It usually reveals itself in Stages III and IV, where survival is poor. 

Women with a strong family history and those who have never given birth are at higher risk of developing this disease, whose cause is as yet unknown. It usually presents at a later age, mostly after menopause. There are no specific telltale symptoms but vague symptoms such as abdominal pain and bloating, loss of appetite/weight, pressure/fullness in the pelvis and a change in bladder and bowel habits should be brought to your doctor’s attention. 

Examination can lead the doctor to suspect an ovarian tumour, but ultrasound, CT scan and MRI can detect the tumour with certainty. We offer OvPlex, an early detection ovarian cancer detection test. 

In addition, ultrasound examination of the ovaries is a good indicator of the development of ovarian tumour. A blood test for a tumour protein (CA125) is usually performed together with the imaging test. 

Surgery involves a hysterectomy and removal of both ovaries and as much tumour tissue within the abdomen as possible.

3. Uterine Cancer

Uterine cancer usually occurs after menopause, and presents with abnormal bleeding in the menopausal patient. 

Women with a family history of cancer, those with obesity, poor blood sugar control and evidence of excess/unopposed estrogen through their reproductive years are at a higher risk of developing uterine cancer. 

Diagnosis usually involves sampling the endometrial lining either by dilation and curettage (D&C) or in an outpatient setting by an endometrial sampling device. Ultrasound and hysteroscopy can guide the choice of sampling method used. 

The standard therapy involves removing the seat of the disease, via a hysterectomy. In specific situations, radiotherapy and hormonal treatment may be useful. Fortunately, this disease is usually picked up at an early stage, and prognosis is good.

4. Vulval Cancer

Cancer of the vulva is rare in that it accounts for only four out of every 1000 cancers diagnosed. It usually presents with a lump, ulcer or itch at the vulva. Diagnosis involves a biopsy of the suspicious lesion, and treatment is usually surgical.

5. Vaginal Cancer

Vaginal cancer is the rarest of gynaecological cancers. Fetal exposure to the drug diethylstilbestrol (DES) has been identified as a risk factor, and this drug is no longer used in pregnancy. It can present with abnormal vaginal bleeding, vaginal discharge, pain and a lump at the interoitus. Occasionally, abnormal cells may be identified at a pap smear. Depending on the site, size and pathology of the lesion, treatment may be surgical, radiotherapy or chemotherapy. Prognosis will depend on the pathology and the extent of spread at the time of diagnosis.