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Gynaecological cancers comprise the top 10 most common cancers affecting Singaporean women. In this issue of HealthNews, we take a look at the 3 most common gynaecological cancers, their warning signs, and how to prevent them.

Gynaecological cancer is any cancer that begins in a woman's reproductive organs. It includes cancers of the uterus, ovary, and cervix, which account for the 4th, 6th and 10th most common cancers in women in Singapore¹.

With more than 6,000 gynaecological cancer cases affecting Singaporean women from 2015–2019, it is important for women to be aware of the signs and symptoms of various gynaecological cancers. This is especially so as gynaecological cancers are known as ‘silent killers’ with symptoms that generally do not present until at the advanced stages.

Main types of gynaecological cancers

1. Uterine cancer

Uterine cancer—also known as endometrial cancer—is a type of gynaecological cancer that begins in the uterus, the organ where fetal development occurs.

Common signs and symptoms of uterine cancer include:

• Abnormal vaginal bleeding after menopause
• Heavy or prolonged bleeding between periods
• Bloody or smelly vaginal discharge
• Pain in the pelvic area

The risk of uterine cancer is increased by conditions that prolong stimulation or exposure to the estrogen hormone. Uterine cancer is thus more likely to be diagnosed in older women who have undergone menopause, are obese, have few or no children, experience early menstruation and/or late menopause, or are on estrogen-only hormone replacement therapy.

Some inherited conditions, such as Lynch syndrome, can also increase the risk of uterine cancer. Fortunately, uterine cancer is highly treatable, with a >90% chance of cure with early detection and treatment.

2. Ovarian cancer

Ovarian cancer arises from the uncontrolled growth of malignant cells in the ovaries. There are three subtypes of ovarian cancer: epithelial ovarian cancer, germ cell tumours, or stromal tumours.

The general signs and symptoms of ovarian cancer are:

• Abdominal bloating and swelling
• Indigestion, gas or nausea
• Loss of appetite or weight loss
• Changes in bowel habits e.g. constipation
• Abnormal bleeding after menstruation and menopause
• Pelvic pain and discomfort

The risk of ovarian cancer increases with age. Other risk factors such as family history, obesity, postmenopausal hormone replacement therapy, endometriosis, early menstruation or late menopause, and never having been pregnant, can also increase the risk of disease.

3. Cervical cancer

Cervical cancer is cancer arising from the tissues of the cervix, the organ that connects the uterus and vagina.

The main types of cervical cancer are squamous cell carcinomas (SCCs) or adenocarcinomas. Other types of cancer, including melanoma, sarcoma and lymphoma, can also develop in the cervix.

About 80–85 percent of cervical cancers are caused by the human papillomavirus (HPV). The common signs and symptoms of cervical cancer include:

• Vaginal bleeding after intercourse, between periods, or after menopause
• Bloody, heavy or smelly discharge
• Pelvic or back pain
• Painful or difficult urination
• Chronic constipation and feeling of presence of stool even though bowels are empty

The risk of cervical cancer is higher in women who are sexually active from a young age and/or have multiple sexual partners, have a family history of the disease, or smoke regularly. Fortunately, cervical cancer is highly preventable and treatable when detected early with regular screening.

Preventing gynaecological cancers

Knowing your risk for gynaecological cancers and undergoing any recommended screening available for the prevention of disease is key to early detection and treatment.

Currently, national population screening programmes in Singapore have only been implemented for the screening of cervical cancer. Singaporean women aged 25–29 who are sexually active are invited to take a Pap test—also known as Pap smear—every three years to detect pre-cancerous cells, while those aged 30 and above are invited to take a HPV test every five years, to detect high-risk cancer-causing HPV strains. HPV vaccinations are also available for women aged 9–26 years old.

There is currently no standard or routine screening for ovarian and uterine cancers. However, women are advised to go for regular testing if they are at higher risk of developing the disease, or if they have a family history of cancer. Looking out for the common signs and symptoms associated with the disease can also help detect the cancer early. Besides these steps, maintaining a healthy weight, a healthy diet, regular exercise, and smoking cessation can help lower the risk of developing gynaecological cancers as well as other chronic diseases.