Gynaecological Cancer Diagnosis & Treatment in Singapore
Gynaecological oncology is a specialised branch of medicine that deals with cancers of the female reproductive system. At OncoCare, several of our medical oncologists are gynaecologist cancer specialists with extensive training in the diagnosis and treatment of these types of cancers. We are able to identify, diagnose, stage, and recommend treatments for gynaecological cancer in Singapore.
What are the Gynaecological Cancer Treatments in Singapore?
Gynaecological Cancer Treatment: Chemotherapy
Chemotherapy uses drugs to kill malignant cancer cells in the affected organs of the body. These medications specifically target tumour cells compared to normal cells, making use of the mechanisms within cancer cells to attack and kill the targeted cell.
Not all gynaecological cancer patients will require chemotherapy. Chemotherapy, if needed, can be given at various stages:
(A) Adjuvant setting (after surgery when there is no evidence of spread of cancer cell to other sites or organs in the body): Postoperative adjuvant chemotherapy is often used to reduce the risk of recurrence and improve patients’ overall survival rate by targeting any remaining cells that cannot be picked up by tests. Not all gynaecoogical cancers may use adjuvant chemotherapy; your doctor will advise you on the need for adjuvant chemotherapy based on the cancer type.
(B) Neoadjuvant setting (before definitive surgery): Preoperative neoadjuvant chemotherapy can post advantages for larger tumours, and is shown to have positive effects on survival for various gynaecological cancers. Neoadjuvant settings are typically used to downstage (or reduce) a tumour’s size before pursuing other forms of treatment such as surgery or radiotherapy. It is often prescribed when the initial tumour is too large to be operable or where surgery may pose risks to other affected organs. It is commonly used to downsize bulky advanced ovarian cancer prior to surgery to improve the chances of a successful surgery.
(C) Advanced setting: Advanced setting chemotherapy is used as a first-line of treatment in stage IV disease when the cancer has already metastasised or spread to distant organs and sites.
Chemotherapy is typically administered over a five to six-month period, with intermittent treatment and resting phases of one to three weeks. Almost all chemotherapy treatment at our clinic in Singapore is administered on-site in a comfortable outpatient setting. Chemotherapy can be administered as pills, intravenous (IV) drips, subcutaneous injections below the skin, topical creams, or muscular injections depending on the recommendation of your cancer specialist.
Chemotherapy also affects and kills normal cells during the treatment process, leading to various side effects. Side effects vary across individuals, drug types, and treatment regimens. Common chemotherapy side effects include nausea, appetite loss, hair loss, gastrointestinal distress, bruising, pain, and fever. Some chemotherapy drugs may cause temporary hair loss. Cold cap or scalp cooling can help to minimise hair loss in women undergoing such treatments. Many recent advances in the field of oncology have resulted in drugs to help effectively mediate common chemotherapy side effects such as nausea.
For certain gynaecological cancers such as uterine cancer, chemotherapy could potentially affect fertility or trigger early-onset menopause which may be a concern for patients who intend to have children in the future. Your oncologist can discuss potential side effects with you before recommending a treatment plan, and can recommend alternative treatments if possible.
Early stage cancers may not require chemotherapy as a necessary treatment. Your gynecologic oncologist will be able to assess your suitability for chemotherapy, and can help perform tests to ascertain which treatment is best for you.
Gynaecological Cancer Treatment: Radiation Therapy
Radiation therapy (or radiotherapy) uses high-energy X-ray radiation to target and kill gynaecological cancer cells. Radiotherapy is often used for gynaecological cancer treatment and is administered over a period of several weeks.
Your oncologist or oncology team will plan and map out a specific radiation field to avoid major organs. Radiation therapy may affect healthy cells near or around the tumour leading to side effects such as skin irritation and sensitivity, vaginal bleeding, fatigue, urinary issues, and gastrointestinal issues such as diarrhea.
There are several types of radiation therapy including external beam (EBRT) and brachytherapy. Brachytherapy (also known as internal radiotherapy) is when the radiation is internally administered to the cancer cells using applicator tubes placed within the patient’s body. This allows the radiation source to more directly target the tumour without affecting surrounding tissue. Brachytherapy is typically performed under anaesthetic so the applicators and a catheter can be inserted; the subsequent therapy sessions can take place in outpatient settings, with the applicators and catheter only being removed after the final radiotherapy session.
TomoTherapy® is another relatively new radiation therapy treatment for vulvar cancer that combines radiation therapy with computed tomography (CT) scanning technology. TomoTherapy creates a 3D image of the vagina so that radiation beams can target the tumours accurately including in highly specific or small areas. Because less radiation reaches healthy tissues, post-surgical gastrointestinal or issues concerning lack of normal sexual function are limited.
Gynaecological Cancer Treatment: Surgery
Surgery may be a recommended treatment option for some forms of gynaecological cancer. The stage and characteristics of the cancer will affect your oncologist’s treatment recommendations, and we advise you to consult a gynaecological cancer specialist for further information pertaining to your specific condition.
Gynaecological Cancer Treatment: Targeted Therapy
Targeted therapy is a form of gynaecological cancer treatment that uses specific drugs to identify, attack, and kill malignant cancer cells without damaging nearby normal cells or tissue. Targeted therapies can affect the cancer cell in various ways including its growth, division, repair, or cellular interaction mechanisms.
One way to slow or stop gynaecological cancer growth is through administrating angiogenesis inhibitors such as Bevacizumab (Avastin). Angiogenesis inhibitors attach to the protein that signals the formation of new blood vessels, rendering the tumour unable to receive new blood vessels in order to grow. Bevacizumab has been shown to shrink advanced epithelial ovarian cancers, with improved outcomes when paired with other treatments such as chemotherapy.
Another targeted therapeutic agent used in treating gynaecological cancer is poly(ADP)-ribose polymerase (or PARP) inhibitors such as Olaparib (Lynparza) and Niraparib (Zejula). PARP enzymes in your body help repair damaged DNA within cells, and PARP inhibitors are used to block this process in cancerous cells. This leads to the death of the cancer cell. PARP inhibitors are often used to treat advanced ovarian cancer in particular, ovarian cancers that harbour BRCA mutation or are HR-deficient (HRD) as these cancers tend to derive greater benefit from PARP inhibitors.
Antibody-drug conjugates (ADC) such as Tisotumab vedotin-tftv (Tivdak) are monoclonal antibodies that can be used in tandem with chemotherapy to target tissue-factor (TF) proteins on cancer cells. ADCs attach onto the targeted cell, bringing with it the chemotherapy drug. This can increase the efficacy of chemotherapy, and is often used to treat metastasised or recurrent cervical cancer.
Each targeted therapeutic agent comes with its own unique profile of side effects, and your doctor will be able to recommend which one is best suited for your condition. Possible side effects of targeted therapies include high blood pressure, tiredness or fatigue, nausea, blood clots or bleeding issues, or fistula formations in your reproductive organs. Your gynaecologic oncologist will closely monitor you following the administration of targeted therapies in order to detect any potential side effects or post-treatment complications.
Gynaecological Cancer Treatment: Immunotherapy
Another option is through using immune check-point inhibitors such as anti PD-1 or anti-PD-L1 antibodies. Immunotherapy boosts our body immune system to fight and eradicate cancer. In normal cellular processes, a type of check-point protein is produced to ensure an immune response to protect the cell. By interrupting or inhibiting this process using immune check-point inhibitors, the body’s immune cells such as T-cells are able to attack and kill the cancer cells – leading to eradication of cancer cells. Immune check-point inhibitor therapy has proven successful for endometrial and cervical cancers.
Oncologists at OncoCare with Clinical Interests in Gynaecological Cancers
Cancer is a serious disease that can severely upset the daily lives of patients and their loved ones. In cancer types such as gynaecological cancer where signs and symptoms might be more internally situated, early detection is key to faster diagnosis, treatment, and recovery. If you are experiencing symptoms that could be indicative of cancer, it is important to seek out an oncologist in Singapore for specialised treatment as soon as possible.
OncoCare’s team of oncologists have specialist experience in diagnosing, staging, screening, and treating a variety of gynaecological cancers.
Senior Consultant, Medical Oncologist
MBBS (Singapore) – ABIM Int. Med (USA) – ABIM Med Onc(USA) – FAMS (Medical Oncology)
Dr. Tay has been recognised as one of the top cancer doctors doing research. He was awarded the prestigious center grant by the National Medical Research Council of Singapore. He actively collaborates with other leading Asian researchers based in Korea, Taiwan, Hong Kong and USA. Dr Tay has published his findings in numerous journals, including Nature Genetics, the Journal of Clinical Oncology, The Lancet Hematology, American Journal of Medicine, Leukemia & Lymphoma and Seminars in Hematology.
Dr Tay’s subspecialty interest is in women related cancers such as breast cancers & gynaecological cancers, melanoma, brain cancers, soft tissue & bone sarcomas and also hematological malignancies such as lymphoma, multiple myeloma and leukemia.
- Graduated from the National University of Singapore in 1998.
- Board Certified, Internal Medicine, American Board of Internal Medicine, 2006
- Board Certified, Medical Oncology, American Board of Internal Medicine, 2009
- Chief Resident, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 2006
- Chief Fellow, Medical Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, 2008
Senior Consultant, Medical Oncologist
MBBS (Australia, Honours), MRCP (United Kingdom), MD (United Kingdom)
Dr Lim specialises in the treatment of gynaecological cancers, such as cancer of the ovary, uterus, cervix and vulva. She trained under several renowned oncologists, including Professor Hani Gabra, a world renowned expert on ovarian cancer.
Dr Lim joined the Department of Gynaecological Oncology at KK Women’s and Children’s Hospital, specialising in the treatment of gynaecological cancers (cancers of the ovary, uterus, cervix and vulva). She also led the Chemotherapy Centre at KK Hospital and served as chairperson of the Singapore Cancer Network (SCAN).
- Graduated from Monash University, Australia (Honours) in 1996
- MRCP (UK), Royal College of Physicians of the United Kingdom, 2001
- Certification in Medical Oncology by the United Kingdom Postgraduate Medical Education Training Board in 2008
- Doctor of Medicine (MD) , United Kingdom in 2009
- Executive Committee Member of the GyneCologic Cancer Group Singapore (GCGS) since 2018
- Former Senior Consultant Medical Oncologist at the Department of Gynaecological Oncology at the KK Women’s and Children’s Hospital (KKH), Adjunct Associate Professor at DUKE-NUS Medical School
- Visiting Consultant at KK Women’s and Children’s Hospital
What are the Signs and Symptoms of Gynaecological Cancer?
Gynaecological cancers are some of the most common cancers affecting Singaporean women today. Uterine, ovarian, and cervical cancer are within the top 10 most common cancers experienced by Singaporean women, and it is crucial for women to stay vigilant and keep an eye out for potential signs and symptoms. If possible, screenings such as PAP smears for cervical cancer can also help detect early signs.
Each type of gynaecological cancer manifests with different signs and symptoms, and they are not the same for all women, even if they have the same type of cancer. It’s important that you pay attention to your body so that you understand what’s normal for you. This helps you identify abnormalities and changes that could be warning signs of gynaecological cancer. Symptoms may include:
- Any unusual vaginal bleeding
- Any vaginal bleeding after menopause
- Unusual vaginal bleeding between periods for pre-menopausal women
- Feeling full too quickly or difficulty eating, bloating, and abdominal or back pain are common symptoms for ovarian cancer only
- Pelvic pain or pressure is a common symptom of ovarian and uterine cancers.
- More frequent or an urgent need to urinate and/or chronic constipation are common symptoms for ovarian and vaginal cancers.
- Itching, pain, burning, or tenderness of the vulva are found only in vulvar cancer. Other symptoms are changes in the colour of the vulva or skin. This can include a rash, sores, or warts.
Gynaecological Cancer Screening
There are no screening tests for most gynaecological cancers, with the exception being cervical cancer which can be screened by PAP smears or HPV testing. As there is a lack of reliable screening for all the other types of gynaecological cancer, it is important to recognise early warning signs and seek proactive care if you suspect you are experiencing symptoms.
What are the Types of Gynaecological Cancer?
Gynaecological cancer is when cells in any female reproductive or genital organ begin to grow out of control. There are five main kinds of gynaecological cancer: ovarian, cervical, uterine, vaginal and vulvar cancer. Rarer types of gynaecological cancer include fallopian tube cancer, gestational trophoblastic neoplasia (GTN), and uterine sarcomas. Though termed under “gynaecological cancers”, these cancers are unique with different risk factors, presentations and require treatment that is individualized for the particular cancer type.
What are the Causes and Risk Factors of Gynaecological Cancer?
As there are several types of gynaecological cancers, the potential causes and risk factors may differ across the various types. Many women who get gynaecological cancer may not experience any of these risk factors at all. There are also no specific risk factors that are the direct cause of gynaecological cancer, and some risk factors can be countered but others are completely beyond a woman’s control, like her age or her family history. Some risk factors that could increase your risk of gynaecological cancer are as follows:
- The sexually transmitted virus Human Papillomavirus (HPV) infection can progress into cervical cancer – talk to your doctor about HPV vaccinations and other ways to reduce your chance of HPV infections
- DES, a synthetic estrogen that doctors used to prescribe to women before 1971 to prevent miscarriage, has been shown to have caused health risks to several mothers and their unborn children, including the possibility of developing cancer – if you or your mother used DES before 1971, talk to your gynaecologic oncologist for more information
- If you are HIV-positive or have AIDS, you are at risk of developing cervical cancer – your doctor will be able to help you with the steps you need to take to minimise your risk
- Smoking of cigarettes and/or tobacco
- Age – the risk increases as one grows older, and women between the years of 50-60 have a higher risk of developing gynaecological cancers compared to younger women
- High blood pressure
- Having Polycystic Ovarian Syndrome (PCOS), Endometriosis, Endometrial polyps (abnormal growths on uterine lining), or other chronic endocrine/tissue-related disorders that affect the female reproductive system and hormones
- Early menarche age (when menses first started) or late menopause age
- Women who have not had any children before
- A history of gynaecological cancer in your family, especially if it’s your mother, daughter, sister, or a female relative
- Having had gynaecological cancer or any other type of cancer previously
- Inherited genetic mutations that may increase your risk of gynaecological cancer – for example, BRCA mutations and may increase your risk for ovarian cancer whilst mutations in the mismatch repair genes (Lynch syndrome) may increase the risk of ovarian and endometrial cancers.
Lifestyle changes that can help reduce or eliminate risk factors include:
- Having protected (rather than unprotected) sex with your sexual partner
- Limiting or abstaining from cigarettes and/or tobacco
- Regular physical activity or exercise to maintain a healthier weight
There is no strong evidence of a link between diet and gynaecological cancer but a healthy and well balanced diet which includes vegetables, fish, and less red meat is beneficial for general health and well-being.
What are the Stages of Gynaecological Cancer?
Because gynaecological cancer refers to multiple specific diseases, there is no unified staging system for all gynaecological cancers. Each specific type of cancer has its own unique system for determining the stage the disease is at and its severity. However, the progress of all gynaecological cancers is followed using a four-stage system similar to other types of cancer. In terms of this system, Stage I is the least severe and Stage IV the most severe.
Both the stage and the type of gynaecological cancer will affect the treatment options that will be available to you. Your doctor, gynaecological cancer specialist, or gynecologic oncologist will work with you to determine the best possible treatments for your unique case and the stage your illness has reached. Your doctor may recommend one or more of many possible available cancer treatments to help you treat your cancer with as little disruption to your life and your health as possible.