Do you know the names of the five more common gynaecological cancers? Are you aware that ovarian cancer and cervical cancer are among the top 10 most common cancers in females in Singapore?

Dr Wong Wai Loong, Consultant from the Department of Gynaecological Oncology at KK Women's and Children's Hospital, gives detailed answers to your questions.

Question by salim100569

Dear Sir, My mother has been diagnosed with cancer and has undergone hysterectomy + removal of the appendix and part of the intestine. The report from the pathologist says: "This poorly differentiated adenocarcinoma with signet ring cells may represent Krukenberg tumor of the ovaries. The primary may in fact be in the appendix" An IHC will soon be performed. My question is: Is there a treatment in this case? Regards.

Answered by Dr Wong Wai Loong, Consultant, Department of Gynaecological Oncology, KK Women’s and Children’s Hospital

I am sorry to hear about your mother’s condition. This is a primary colorectal cancer that has spread to the ovaries. Hence, you may wish to consult a colorectal surgeon to advise on the management of the cancer.

The following reply is answered by: Dr Fu Wan Pei Cherylin, Consultant, Department of Colorectal Surgery, Singapore General Hospital

Krukenberg tumour of the ovaries means that cancer cells have spread from a primary tumour in the gastrointestinal tract (such as stomach or colon) to one or both ovaries. From the histology report, it appears that the reader's mother had a primary appendiceal or colonic cancer that had already spread to the ovaries at time of diagnosis and surgery. This is considered stage IV colonic cancer. Treatment for this may involve surgery to remove the segment of intestine containing the primary tumour as well removing both fallopian tubes and ovaries. Chemotherapy is also often required after surgery. Prognosis then depends on whether there is further spread of the cancer to other organs such as the liver, lungs or peritoneal cavity.

Reposted by Administrator

I am concerned about my nieces, aged 19 and 22. They recently lost their mother to cervical cancer (after battling it for about 18 months). Her initial diagnosis of a fibroid (she went to the doctor because she had pelvic pain and was bleeding heavily) eventually turned out to be late stage cervical cancer (she got a second opinion from another doctor when the pains in the pelvic region got worse). I have an 18-year-old daughter who is very close to her cousins and I would like to know how to help the 3 of them:

1. Is this hereditary? (The girls' mother doesn't have a family history of it, that she knows of, so she didn't think it was possible to have cervical cancer).
2. I understand that early stage cervical cancer does not present any symptoms (the girls' mother wouldn't have gone to the gynae if she hadn't been bleeding or in so much pain). What can the girls do to prevent it (actually, can it be prevented)?
3. I was told about HPV vaccines but are they recommended for girls these age? And how many will they need in their life?
4. Should they be screened for cervical cancer before getting the vaccine shot?

Answered by Dr Wong Wai Loong, Consultant, Department of Gynaecological Oncology, KK Women’s and Children’s Hospital

I am sorry to hear of the loss of your loved one. Cervical cancer is usually caused by a virus known as human papillomavirus (HPV). You can get HPV by having sexual contact with someone who has it, or persistent infection with the virus. It is not hereditary. During the early stages of cervical cancer, symptoms may not be present. Hence, I would strongly suggest that your daughters be vaccinated against HPV. Based on the current evidence, three doses of the HPV vaccine is sufficient for a lifetime, and there is no need for screening before vaccination.

Reposted by Administrator

Dear doctor, I have been trying to find out more about whether one can get ovarian cancer even after a hysterectomy. My aunt (mum's sister) recently had a hysterectomy (ovaries still intact) done because she had severe endometriosis. But I hear that although the chances of getting ovarian cancer is reduced, one can still get it. What are the chances of ovarian cancer happening after a hysterectomy and is there anything to prevent it? Will my mum (she's 55) have higher chances of getting ovarian cancer and how can she prevent it? Thank you S. Chin.

Answered by Dr Wong Wai Loong, Consultant, Department of Gynaecological Oncology, KK Women’s and Children’s Hospital

As long as the ovaries and fallopian tubes are intact, there is always a risk of ovarian cancer developing. There are a few risk factors for developing ovarian cancer, and having endometriosis is one of them. Besides that, other risk factors include not having children, infertility, and smoking. Genetic inheritance for ovarian cancer only occurs in 10 percent of cases, and 90 percent are sporadic. There is currently no effective screening for ovarian cancer. Unfortunately, most ovarian cancers present at a late stage. The symptoms of ovarian cancer are very vague and non-specific. They consist of abdominal bloatedness, constipation, loss of weight, loss of appetite, abnormal vaginal bleeding, just to name a few. Many patients with ovarian cancer have visited many doctors with vague symptoms before seeing a gynaecologist. As your mom is 55 years of age, she should still go for her regular pap smear, and undergo an examination. She should also be conscious of her abdominal girth and seek medical attention if she feels that her abdomen is getting bigger.

Ref: Q15