HPV is a common viral infection that will infect most people in their lifetimes, but usually clears up without need for treatment. It is transmitted through intimate contact and is extremely common in people who have had sex before. It does not usually cause any symptoms. HPV has many strains and can be classified as “low risk HPV” and “high risk HPV”. Low risk HPV types may cause genital warts but not cancer. High risk HPV types can cause pre-cancerous changes which may eventually lead to cervical cancer if there is no intervention.
There is now a HPV vaccine available, which offers good protection against HPV.
Cervical cancer screening detects precancerous changes in the cervix and allows for early intervention to prevent invasive cancer from developing. Pap smears were previously used for this. Research has now shown that for women aged 30 years and above, a human papilloma virus (HPV) test is better than a Pap smear for screening.
A HPV test is done similar to how a Pap smear is performed. A brush is used to lightly brush the cervix and analysis is performed to check for the presence of high risk HPV. Because the HPV test is more sensitive than the traditional Pap smear, the screening interval for a negative test result is 5 years (instead of the traditional 3 years).
HPV primary testing is recommended for women 30 years and above. Women aged 25 to 29 years old should continue with routine Pap smears as HPV testing is not recommended in this age group due to a high incidence of temporary HPV infection.
Yes. As long as you have had sex before, it is recommended that you have regular cervical cancer screening.
A positive HPV test does not mean you have cervical cancer. Depending on the result, you may require a Pap smear test to check if the HPV infection has resulted in any pre-cancerous changes in the cells of the cervix. If there has not been any cell changes, you will simply require follow-up as most HPV infections (90%) will be cleared by your natural immune system over time.
Photo credit (cover image): Department of Pathology, Calicut Medical College / Wikimedia Commons
This article focuses on HPV vaccine.
Human Papilloma Virus is a common viral infection that will infect most people in their lifetimes, but usually clears up without need for treatment. It is transmitted through intimate contact and is extremely common in people who have had sex before. It does not usually cause any symptoms. There are many different types of HPV. Low risk HPV types cause genital warts but not cancer. High risk HPV types can cause pre-cancerous changes which may eventually lead to cervical cancer if there is no intervention.
The HPV vaccine can prevent cervical cancer by protecting against certain strains of HPV infection. Vaccination has been shown to protect against 70-90% of cervical cancers if given before onset of sexual activity (depending on vaccine type). Although the vaccine cannot treat current infection, it can still offer some protection for those who are sexually active or already exposed to HPV. It is a 2-dose regime (0 and 6 months) for girls/boys aged 9 to 14 years, and a 3-dose regimen (0, 2, 6 months) for girls/boys aged 15 years and above. It is currently licensed from 9 to 26 years old but is safe to be given for those above 26 years old as well.
It is a very safe vaccine with minimal side effects. The most common side effects are pain, slight swelling/redness at the injection site, and temporary headache.
Yes. Protection is not 100% and it is recommended that you have regular cervical cancer screening.
| Types of HPV vaccine | Cervarix | Gardasil-4 | Gardasil-9 |
| Coverage | HPV 16/18* | HPV 16, 18*HPV 6, 11+ | HPV 16, 18, 31, 33, 45, 52, 58*HPV 6, 11+ |
| Medisave cover | Yes | Yes | No |
*16/18 causes 70% of all cervical cancers. 16/18/31/33/45/52/58 causes 90% of all cervical cancers
+ 6, 11 causes genital warts
This is a condition where the lining of the uterus becomes too thick. Although it is not cancer, it can progress to cancer of the uterus in some cases if left untreated.
The lining of the uterus responds to female hormones. Estrogen is involved in the first half of the cycle, where the lining grows and thickens. After an egg is released (ovulation), progesterone comes in to prepare the lining of the uterus for pregnancy. If fertilisation does not occur, the lining is shed and a new cycle begins.
Endometrial hyperplasia occurs when there is excess estrogen without progesterone. This happens when ovulation does not occur and progesterone does not come in. The lining of the uterus continues to grow, the cells of the lining start to crowd together and there is no shedding. If this continues, it may eventually lead to cancer.
Abnormal bleeding is usually the first sign of endometrial hyperplasia. These include:
Your gynaecologist will advise you on the type of endometrial hyperplasia you have, including:
Atypia increases the risk of progressing to cancer.
A transvaginal pelvic ultrasound scan is useful to measure thickness of the lining of the uterus; however, the only way to confirm would be through a biopsy of the uterus lining. This is either done in the clinic (endometrial pipelle), or as a day surgery under general anaesthesia (hysteroscopy dilation and curettage (D&C)). The biopsy will need to be examined under a microscope to diagnose endometrial hyperplasia, and whether atypia is present.
This depends on your age, medical conditions, fertility plans, type of hyperplasia and willingness for long-term follow-up. Options include:
Photo Credit: Mikael Häggström / Wikimedia Commons
Ovarian cancer is cancer arising from one or both of your ovaries. The majority of ovarian cancer arise in older women. 9 out of 10 cases are epithelial ovarian cancer, which is a cancer that develops from the cells surrounding the outer layer of the ovary.
In many cases, the exact cause is not known. Some risk factors may include:
Unfortunately, many women do not have symptoms until ovarian cancer is late stage. Symptoms are usually vague and may include:
Your gynaecologist will need to take a detailed medical history and perform a pelvic examination for you. A transvaginal ultrasound will be done to check your uterus and ovaries. Blood tests (tumour markers e.g. Ca125) may be advised. Depending on your ultrasound and blood test results, you may be asked to go for further imaging e.g. CT scan. If there is fluid in your abdomen, some may be drained for testing. Another way to look into your abdomen directly is laparoscopy (keyhole) surgery, where biopsies can also be taken.
Staging of the cancer is next. In some cases, this can only be confirmed after surgery is done. In general –
Stage 1: cancer is in the ovary/ovaries only
Stage 2: cancer has spread beyond the ovaries, but has not spread beyond the pelvis
Stage 3: cancer has spread beyond the pelvis, but not involved other parts of the body
Stage 4: cancer has spread to other parts of the body e.g. to the liver, lungs etc
This depends on your age, general health, medical conditions and stage of cancer. Treatment can involve surgery, chemotherapy and/or radiotherapy. Your gynae-oncologist will be able to discuss with you about the options suitable for you.
Surgery usually involves hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) and/or possible lymphadenectomy (removal of lymph nodes in the pelvis and abdomen to check for cancer involvement), omentectomy (removal of fat pad in the abdomen) and removal of appendix in some cases.
For chemo- and radio-therapy, your gynae-oncologist will manage you together with a medical oncologist to optimise your treatment.
Photo Credit: Cancer Research UK / Wikimedia Commons
Endometrial cancer is cancer arising from the lining of the uterus.
There are many risk factors for endometrial cancer, although not every woman with endometrial cancer has risk factors in their history. Risk factors include:
The most common symptom is abnormal bleeding. These can include:
Your gynaecologist will need to take a detailed medical history and perform a pelvic examination for you. A Pap smear/HPV test will be taken if you have not had one recently, as cervical cancer can also have similar symptoms. A transvaginal pelvic ultrasound will be done to check your uterus, uterine lining thickness and ovaries. One of the following tests will be recommended to obtain tissue from your uterine lining for microscopic analysis:
Your biopsy should state if you have a low-grade or high-grade cancer – this is a description of how abnormal the cancer cells look and how likely/fast they are likely to spread. Staging of the cancer is next. You will be asked to go for further imaging e.g. CT or MRI scans to check if the cancer has spread within your uterus or outside your uterus to the other parts of your body. In general –
Stage 1: cancer is found in the uterus only
Stage 2: cancer has spread to the cervix (neck of womb) only
Stage 3: cancer has spread beyond uterus and cervix but is still confined within the pelvis
Stage 4: cancer has spread outside of the pelvis
This depends on your age, general health, medical conditions and stage of cancer. Treatment can involve surgery, chemotherapy, radiotherapy or hormone therapy. Your gynae-oncologist will be able to discuss with you about the options suitable for you.
Surgery usually involves hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) and/or possible lymphadenectomy (removal of lymph nodes in the pelvis and abdomen to check for cancer involvement).
For chemo- and radio-therapy, your gynae-oncologist will manage you together with a medical oncologist to optimise your treatment.
Photo Credit: Lolaia / Wikimedia Commons
Cervical cancer is cancer arising from the neck of the womb.
The top reason for cervical cancer is persistent high risk human papillomavirus (HPV) infection. Read more about HPV in cervical cancer screening and how to prevent infection through a HPV vaccine.
The most common symptom is abnormal bleeding or vaginal discharge. Some women can have no symptoms at all, especially in the early stages. Symptoms can include:
Your gynaecologist will need to take a detailed medical history and perform a pelvic examination for you. Depending on the appearance of your cervix, you may need a Pap smear/HPV test, colposcopy and/or biopsy. A colposcope magnifies your cervix to better identify areas of abnormalities for biopsy – this can usually be done in the clinic.
Staging of the cancer is next. You will be asked to go for further imaging e.g. CT or MRI scans to check if the cancer is confined to your cervix or has spread beyond. In general –
Stage 1: cancer is in the cervix only
Stage 2: cancer has spread beyond the cervix and uterus, but has not spread to the pelvic walls or lower part of vagina
Stage 3: cancer has spread to the pelvic walls or lower part of vagina, with possible lymph node involvement
Stage 4: cancer has spread outside of the pelvis e.g. to the bladder, rectum, lungs etc
This depends on your age, general health, medical conditions and stage of cancer. Treatment can involve surgery, chemotherapy and/or radiotherapy. Your gynae-oncologist will be able to discuss with you about the options suitable for you.
Surgery usually involves total hysterectomy (removal of the uterus and cervix) and/or possible lymphadenectomy (removal of lymph nodes in the pelvis and abdomen to check for cancer involvement).
For chemo- and radio-therapy, your gynae-oncologist will manage you together with a medical oncologist to optimise your treatment.
Photo credit: www.scientificanimations.com / Wikimedia Commons
What is Ca125?
It is a protein called cancer antigen 125, and is measured through a blood test.
I have high Ca125. Should I be worried?
Although women with ovarian cancer often have high Ca125, having a high Ca125 does not always mean you have ovarian cancer. It is important to know that some women with ovarian cancer never have high Ca125.
There are many normal and non-cancerous conditions that can cause raised Ca125. This include:
Your doctor will need to take a detailed medical history, perform a physical examination and do a pelvic ultrasound to determine if you need further tests.
Should I include Ca125 in my health screening?
Not if you are at average risk of ovarian cancer. None of the international professional organisations recommend using Ca125 to screen for ovarian cancer in women in the general population at average risk.
This is because many conditions can cause raised Ca125, which means that Ca125 testing is not specific. Even for women at high risk of ovarian cancer (strong family history, genetic mutations etc), there is no consensus on the usefulness of Ca125 test for early detection.
What is Ca125 useful for?
It is useful for monitoring of ovarian cancer treatment, and to monitor for possible cancer recurrence.
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