In Singapore, the most common gynaecological cancers are uterine cancer, ovarian cancer and cervical cancer.

These are amongst the top 10 most common cancers affecting Singaporean women.

  • Uterine cancer is the most common female genital tract cancer in Singapore. While it can affect women of any age, the majority of cases (70%) occurs in women above the age of 50.

  • Ovarian cancer, the sixth most common cancer among Singaporean women, usually occurs in post-menopausal women over the age of 50, but can also occur in younger women. Epithelial ovarian cancer usually affects older women, while germ cell ovarian cancer tends to occur more frequently in younger women.

  • Cervical cancer is the tenth most common female cancer in Singapore, with more than 200 women diagnosed with this cancer every year. It is however a highly preventable cancer, as it can be detected in the pre-cancerous stages through screening tests (e.g. Pap smear/HPV test).

Learn more about these female cancers from our featured doctor, Clinical Assistant Professor Jack Chan, Consultant from the Department of Breast and Gynaecology, Division of Medical Oncology at the National Cancer Centre Singapore (NCCS). NCCS is a member of the SingHealth group.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.   

1. Question by R*
Hi, two blood tumors in ovary, size 4cm and 3 cm, in ovary for more than 10 years, still exist after menopause for more than 12 years. Cancer marker shown not cancerous, did not grow over the years.  Except for bloating (easily and frequent), constipation or discomfort at times ( not frequent), no other symptoms are noted. Should the tumors be removed together with the ovaries and uterus? Thought I decided to remove both of them together with the tomors a I have concern that it may turn cancerous in future, the ganae is not for it but to review yearly. Your comment please.

Answered by Clinical Assistant Professor Chan:
Hi R*,
I am glad to know that you are on regular follow-up, and have been appropriately counselled by, your gynaecologist. Without additional information on your condition, I assume that you have endometriotic cysts of your ovary, and your gynaecologist is of the opinion that your ovarian condition is not cancerous. It is indeed reassuring that the ovarian findings have not enlarged over 10 years.

I suggest for you to discuss further with your gynaecologist your concern regarding the ovarian condition being cancerous or potentially turning cancerous, and whether it is medically necessary to remove your womb (uterus) and ovaries. Your gynaecologist knows your condition best, having followed you up for more than a decade.
Take care, and stay healthy!

2. Question by A*****
I was diagnosed with Adenomyosis since 2018 and has been following up on the condition every 6 months with Gynae,  taking Visanne to keep the condition under control.  

Given my age at 35, and the medication risks, i'm concerned about risks of ovarian/ uterine/ breast cancer. I just did an MRI to confirm the Adenomyosis diagnosis. The results did not seem to show any irregularities apart from englarged uterus with large adenomyoma. The gynae did not provide much advice on my conerns rgd the cancers. Is there any tests I should do early due to my existing condition? how can i better manage the 3 cancer risks if any?

Answered by Clinical Assistant Professor Chan:
Hi A*****. Thank you for your questions.
A few studies suggest an association (but not a causal link per se) between adenomyosis and endometrial cancer. There are no proven screening procedures for ovarian and uterine cancers, but you are on close follow-up with your gynaecologist for endometriosis so that will allow early detection of any other new gynaecological conditions.

Visanne is a progestogen-only pill. We need more research to know if the progestogen-only pill could slightly increase the risk of breast or cervical cancers in a similar way to the combined pill. Research has not linked ovarian cancer or womb cancer to progestogen-only products.

At 35 years old, you are recommended for a human papillomavirus (HPV) test once every 5 years if you were ever sexually active before. You are also encouraged to do a routine breast self-examination every month, about a week after the start of your menstrual period. After you turn 40 years old, consult your doctor about the benefits and limitations of an annual mammogram up to 49 years.
Take care, and stay healthy!

3. Question by m******
One of my family member is diagnosed with endometrial carcinoma, what is the general term for it and if Is curable @ early stage?

Answered by Clinical Assistant Professor Chan:
Hello m******. Thank you for your questions.
The layman’s terms for "endometrium" and "carcinoma" are "inner lining of the womb" and "cancer", respectively. The medical word for womb is "uterus". Therefore "endometrial carcinoma" refers to cancer arising from the inner lining of the womb. It is alternately known as "uterine carcinoma".

Yes, endometrial carcinoma is curable at an early stage.
Take care, and stay healthy!

4. Question by m***
Hi Dr,
1.Can a female above 30 years old still take the HPV vaccine?
2.Does a female who has never had sex still need to go for PAP smear and HPV tests?

Answered by Clinical Assistant Professor Chan:
Hi M***. Thank you for your questions.
1.The approved indication for adult human papillomavirus (HPV) vaccine in Singapore is for females up to age 26 years because the goal is primary prevention of HPV infection. HPV vaccination may be considered in females aged 27-45 years; vaccination in this age group is not routinely recommended and is therefore excluded from Singapore’s National Adult Immunisation Schedule (also ineligible for subsidies and MediSave claim). A female above 30 years old can discuss HPV vaccination with her doctor; do note that the vaccine is potentially less efficacious if she has ever been sexually active, and may have been exposed to HPV infection.
2.No, a female who has never been sexually active before does not need cervical cancer screening through Pap smear or HPV test.

Take care, and stay healthy!

5. Question by M******
Hello Dr,
Is there any article on why the uterus is growing/joining to the rectum? Is this dangerous and cancerous? Thank you for helping to get this question addressed.

Answered by Clinical Assistant Professor Chan:
Hi M******. Thank you for your question although I am not too sure if I understood it correctly.
The womb (uterus) and rectum are adjacent organs in the female pelvis. A female who is diagnosed with structural abnormalities affecting her womb and rectum should consult her doctor or O&G specialist for further advice.

Otherwise locally advanced cancers of the womb or cervix can invade or even abnormally join (fistulate into) the adjacent rectum or bowel. Such conditions will definitely be symptomatic, and require medical attention and treatment.
Take care, and stay healthy!

6. Question by S****
Dear Dr,
If my HPV's result is negative and the next screen is 5 years from 2020, do I still go for my pap smear this Sep 2022?

Answered by Clinical Assistant Professor Chan:
Dear S****, thank you for your question.
From your question, I infer that your last Pap smear and HPV test were done in 2019 and 2020 respectively.
In Singapore, HPV tests are recommended once every 5 years in females aged 30 years old and above and have ever had sex. Your negative HPV test result in 2020 is reassuring. You should therefore go for your next cervical cancer screening in the form of a HPV test in 2025.
Take care, and stay healthy!

7. Question by A***
Dear Prof Chan,
I have been taking Tamoxifen 20mg daily for one year and 2 months following a lumpectomy of a stage 1A CDIS. Tamoxifen was chosen over Letrozole as my FSH reading was 24.1 and it was not certain if I had been through menopause then. However, my recent gynecology follow-up suggests that I am menopausal. The pelvis ultrasound revealed a likely fibroid of 1.1 x 0,8 cm, the endometrium is 2.3 mm thick, and there is a possible representation of adenomyosis on the posterior uterine wall. The cyst on my right ovary which I had been monitoring seems to have gone. Also, I removed endometriosis cysts in the year 2000. so far I am doing fine on Tamoxifen but I am concerned about the endometrial side effects of Tamoxifen. Should I consider changing my hormone therapy to Letrozole if my conditions permit? 
Thank you.

Answered by Clinical Assistant Professor Chan:
Dear A***. Thank you for your question.
Without additional information on your condition, such as your age and menstrual history, Letrozole is a reasonable alternative to Tamoxifen in women with oestrogen receptor (ER) positive DCIS who are definitely post-menopausal.

I recommend that you discuss your hormonal treatment options with your treating doctor again.
Take care, and stay healthy!

8. Question by R*****
Dear Dr,
I have removed womb, tube and ovaries. Do I still need to do PAP Smear? Thank you.

Answered by Clinical Assistant Professor Chan:
Dear R*****. Thank you for your question.
The answer depends on whether the operation was performed for a non-cancerous or (pre-)cancerous condition, and whether both the womb and cervix or the cervix (neck of the womb) was/were surgically removed (referred as total hysterectomy and partial hysterectomy, respectively).

If a lady had a partial hysterectomy whereby the womb was removed but the cervix remains, she is recommended to continue Pap smears (or human papillomavirus [HPV] tests). 

Similarly, if a lady had a hysterectomy for a cancerous or pre-cancerous condition, regular Pap smears may still be recommended to monitor for cancer recurrence early or pre-cancerous change. However, it is more likely that you have undergone a total hysterectomy for a non-cancerous condition, for which you can stop having Pap smears to screen for cervical cancer.
Take care, and stay healthy!

About Clin Asst Prof Jack Chan

Clinical Assistant Professor Jack Chan is a Consultant Medical Oncologist who practises at National Cancer Centre Singapore (NCCS) and KK Women’s and Children’s Hospital (KKH). His clinical and research interests are on gynaecological and breast cancers.

In addition to caring for his patients, Clin Asst Prof Chan has received accolades for his education and clinical work, including Residency in SingHealth Excels (RiSE) Awards – Outstanding Faculty and Singapore Health Quality Service Awards.

Ref: J22