Top 3 gynaecological cancers
Dr See Hui Ti, Senior Consultant, Medical Oncology, Parkway Cancer Centre, tells us more about these women-only cancers
Gynaecological cancers are cancers that affect only women. They start in the female reproductive system, namely in the cervix or neck of the womb (cervical cancer), ovaries (ovarian cancer), lining of the womb (uterine or endometrial cancer), and in rare cases, in the vulva (vulvar cancer) or vaginal tissue (vagina cancer).
While breast cancer – the Number One cancer among women in Singapore – is usually the first to come to mind when we think of women’s cancers, breast cancer does strike men, albeit rarely – about one per cent of all breast cancer cases are in men.
Meanwhile, like men, women may also suffer from colorectal cancer and lung cancer but here, we will explain more about gynaecological cancers, which strike only women.
Singapore’s top 3
Three gynaecological cancers are among the top 10 cancers to affect women in Singapore.
These are uterine or endometrial (womb) cancer, ovarian cancer and cervical cancer.
Of greatest concern is uterine cancer with its rapidly-rising numbers. Over the last 30 years, incidences of uterine cancer in Singapore have doubled, making it the top gynaecological cancer here today.
1. Uterine cancer
Endometrial or uterine cancer is a cancer in the lining of the womb. Detected at Stage I, the cancer is 70 per cent curable. In about 30 per cent of cases, the uterine cancer may be more aggressive and likely to recur. Largely age-specific, rates rise rapidly during a woman’s perimenopausal stage (around the period when a woman is about to go through menopause) at 40-50 years old.
Risk factors: These include age and prolonged exposure to oestrogen, that is, overstimulation of the endometrial or the lining of the womb by oestrogen, which could be a result of an earlier-than-normal menarche (a girl’s first period) or delayed menopause. Thus having more menstrual cycles in total, such menarche before 12 years old together with a late menopause increases the risks. There is thus no increased risk for women who menarche early but go through early menopause (or start late and undergo menopause late).
Other risk factors include obesity, diabetes and a strong family history of endometrial or colorectal cancer, which also increases the risk of ovarian cancer.
Symptoms: These include post-menopausal bleeding. For example, a 50-year-old who has undergone menopause for several years, who experiences bleeding, should immediately seek medical attention. Likewise, a younger lady who suddenly experiences irregular or extra-heavy cycles should also seek medical advice. This rather “obvious” symptom makes it easier to detect the cancer early.
Treatment: This mainly involves surgery, with 80 to 90 per cent of cases curable by surgery alone. However, in more aggressive cases, patients may be offered treatment such as chemotherapy and radiation to reduce the chances of the cancer recurring.
2. Ovarian cancer
This another cancer on the rise, with increasing weight and family history raising the risks.
Risk factors: For a woman with a first-degree relative (e.g. mother or sister) with ovarian cancer, the risk goes up by five per cent. If one has two first degree relatives, the woman is 10 times more likely than other women to suffer from ovarian cancer.
Other factors include early menarche, never given birth, having had a first child after the age of 30, and late menopause after age 50 – these slightly increase the risk of ovarian cancer as well.
Symptoms: Symptoms for ovarian cancer are hard to detect as the ovaries are hidden in the pelvis. The signs may, therefore, be vague, such as abdominal discomfort (pain or swelling) or pressure in the pelvic area. Screening for ovarian cancer has also not been very effective. Therefore, in approximately 70 per cent of all cases, especially in Western countries, the cancer is only detected at Stage III. In Singapore and Asia, however, the smaller build of Asian women, thankfully, enables the cancer to be detected earlier in up to 50 per cent of cases.
3. Cervical cancer
Cervical cancer is one cancer that has bucked the trend and numbers have been falling over the last 10 years. Once the most common gynaecological cancer in Singapore, it has since fallen to seventh position among women-only cancers, behind uterine and ovarian cancer.
Risk factors: In 90 per cent of cases, the cancer is related to the HPV virus (Human Papillomavirus). Chances of infection are highest at about 17-18 years old but it can take anywhere from five to 20 years from the point of infection to when cervical cancer develops.
As such, screening through Pap smears has made a huge impact in treating cases even before cancer develops. For every 50-60 million women screened, for example, only 10,000 cancers are likely to be found, with many cases treated in the pre-cancer stage.
Symptoms: When symptoms of cervical cancer present themselves, it is likely to be in a more advanced stage. These include abnormal vaginal bleeding, unusually heavy discharge, pelvic pain or pain during urination. The last symptom may signal that the cancer has spread to the bladder.
Treatment: Treatment for cervical intraepithelial neoplasia (CIN), or abnormal growth in the cervix, in the absence of invasive cancer, can be treated by surgery such as LEEP (Loop Electrosurgical Excision Procedure) or Cryosurgery.
Chemoradiation may also be given to better control the cancer and reduce recurrence. This involves a main treatment via radiation with low-dose chemotherapy once a week to boost the effects of radiation.
This was extracted from an online video on PCC’s Webinar Series. To watch the video, go to http://www.parkwaycancercentre.com/multimedia/webinars/top-three-gynaecological-cancers
TOP 10 CANCERS IN SINGAPORE WOMEN
- Breast
- Colorectal
- Lung
- Uterine (womb)*
- Ovarian*
- Cervical*
- Skin
- Stomach
- Lymphoma
- Thyroid
