01  Endometrial Cancer

Most endometrial cancers present with abnormal vaginal bleeding or bleeding after menopause. Fortunately, most endometrial cancers are diagnosed at an early stage due to their early warning signs. Majority of endometrial cancers can be treated with laparoscopic surgery (keyhole surgery). The organs that need to be removed will be the uterus, cervix, both fallopian tubes and ovaries, and lymph nodes. If deemed early stage based on physical examination findings and staging scans done, removal of the sentinel lymph nodes instead of removing all the pelvic lymph nodes can be done. This will reduce the risk of swelling in the lower limbs after surgery. The sentinel node is the most important lymph node, because it is the first node that the cancer will spread to. If that node is tested negative for cancer, we can be rest assured that the rest of the lymph nodes in the pelvis are unaffected by cancer.

02  Ovarian Cancer

Ovarian cancer tends to present at a later stage due to the lack of specific symptoms. Symptoms include bloating, loss of appetite and loss of weight, changes in urine and bowel habits. The main goal of surgery is to resect all the tumour, leaving no visible tumour in the abdomen and pelvis. The surgery includes removal of the uterus, cervix, both fallopian tubes and ovaries, lymph nodes, omentum, possibly the bowel if there is any cancer involvement, and peritoneum (the internal lining tissue of the abdomen and pelvis) if there is any spread of disease. Numerous research studies have proven that optimal debulking surgery (surgery that leaves no visible tumour behind) will greatly enhance the chance of survival and even cure.

03  Cervical Cancer

Majority of cervical cancers are caused by persistent human papilloma virus (HPV) infection. Women with cervical pre-cancer (CIN) and early cervical cancer often have no symptoms. HPV vaccination and regular cervical cancer screening are the best ways to protect against cervix cancer. If screening test results are abnormal, colposcopy and cervical biopsy are required for further evaluation.

As cervical cancer develops and grows, symptoms including abnormal vaginal bleeding, pain and bleeding after sexual intercourse, increase in vaginal discharge occur. In early stages, cervical cancer is mainly treated by surgery. Usually called a radical hysterectomy, the uterus, cervix, tissues at the side of the cervix called the parametrium, and a cuff of vagina, is removed. Pelvic lymph nodes will also need to be removed together with the specimen.

04  Vulvar Cancer

Vulvar cancers present as a growth or sore on the vulva that may be persistently itchy or painful. They can be treated by a radical vulvectomy surgery together with removal of the inguinal lymph nodes. This surgery may be done together with a plastic surgeon to achieve optimal reconstruction cosmesis outcome.

05  Oncofertility Services

Up till recently, oncology and fertility were seldom used in the same sentence. But increasingly, more and more women are being diagnosed with cancers at a young age when fertility is an important consideration. Management requires counselling by both oncologic surgeons and reproductive medicine specialists as treatment is individualized. It requires careful coordination of care to achieve the best possible oncologic outcomes at the same time preserving fertility.

06  Pre-cancer Services

Pre-cancers of the cervix are detected through screening either through HPV testing, PAP smear or both. Once pre-cancers are detected, further evaluation with colposcopy is required. For treatment, a small procedure done to the cervix to either excise or ablate the abnormal lesion can be offered. The difference between the two procedures should be discussed with your gynaecologist as fertility concerns have to be considered.