Whether you’ve got symptoms or not, it never hurts to chat with your doctor about things you can do to stay up to date with your health. Here, we shine the light on five different ways you can get checked for critical health issues – with advice from the
Five procedures that could save your life
#1 Pap Smear
Cervical cancer is on the rise, explains DR NANDINI SHAH, so women are advised to undergo this important screening test.
Symptoms of cervical cancer can include irregular vaginal bleeding or pain during intercourse. However, in many cases, there are no symptoms, she says – which is why regular screening is crucial to catch any cell abnormalities early on.
What exactly is a pap smear?
Also known as a cervical smear, a pap smear test is a method of detecting abnormal cells on the cervix (the entrance of the uterus) to prevent cervical cancer. The test involves collecting a sample of cells from the cervix during a routine pelvic exam. The doctor will insert an instrument called a speculum into the vagina. The speculum holds the walls of the vagina apart and allows a clear view of the cervix. Once the speculum is in place, a spatula or brush is inserted through it to take a swab from the cervix. This may feel a little strange, but only takes a few minutes. Once the doctor or nurse has taken some cells for examination, they will remove the speculum and you will be able to get dressed.
Dr Shah says that treatment for an abnormal pap smear test result is always discussed with one’s health care provider, and follow up largely depends on whether the abnormal cell changes are mild, moderate or severe. In many cases, mild changes usually require a period of observation, as the cells can go back to normal on their own; in this case, another pap smear test would be repeated after a short period of time. However, Dr Shah says that more significant cell changes may require a gynaecology referral for further investigation and, in some cases, the abnormal cells need to be removed before they become cancerous.
International Medical Clinic, #14-06 Camden Medical Centre, 1 Orchard Boulevard 6733 4440 | imc-healthcare.com
#2 Breast Inspections
#2 While a breast examination itself can’t prevent breast cancer, early detection can mean earlier treatment, which ultimately means a better chance of survival. Breast and general surgeon DR GEORGETTE CHAN fills us in on the importance of regular breast examinations, and the different types.
“A monthly self-check is very important because it allows us to detect even subtle changes – like breast lumps, nipple retraction or skin dimpling,” says Dr Chan. “Young women should ideally start doing this in their twenties to become familiar with how their own breasts feel. Seven to ten days after the start of your menses is the best time to do it, because that’s when the breasts are least sensitive.”
What to do if you find a lump
“Firstly, don’t panic, because about 90 percent of lumps detected are benign,” says Dr Chan. “If you find one while you’re close to your menstrual period, it could be due to temporary hormonal changes. So, I suggest waiting until after your period to see if it’s still there. If it is, go to see your GP or a breast specialist.”
Dr Chan recommends that women should start going for medical breast examinations from the age of 40; however, she adds that if someone in your family has had breast cancer it’s wise to come five to 10 years earlier than the age of your relative when her cancer was diagnosed. “Depending on the age of a patient and the density of the breast, I may recommend both a mammogram and an ultrasound,” she says.
According to Dr Chan, mammography has an accuracy rate as high as 90 to 95 percent, and has proven effective in detecting cancers early. Early detection is associated with a 20 percent drop in breast cancer mortality.
As for patients’ concerns over radiation from the mammography machine, Dr Chan says there’s nothing to be worried about. “Though mammography can be uncomfortable, it’s limited to 15 seconds and is not harmful. As for the amount of radiation, it’s a very low dose, akin to that of a couple of chest x-rays and much lower than a PET scan or a CT scan. So, the risk of harm is low, especially if done only yearly (from 40 to 50), and then every two years (from 50 onwards), as we recommend.”
Dr Chan says that, although ultrasound is not effective on its own as a screening tool, it’s a good supplementary tool because it’s better at detecting and delineating small breast nodules.
Georgette Chan Consultancy, #11-09 Mount Elizabeth Medical Centre, 3 Mount Elizabeth 6836 5167 | georgettechan.com.sg
#3 Melanoma Screening
#3 General surgeon DR DENNIS LIM, whose subspecialties include head and back surgery and surgical oncology, chats with us about melanoma, one of the most-feared cancers, and the importance of screening for it.
What exactly is melanoma?
Melanomas are cancers that develop from pigment cells in our skin called melanocytes. There are quite a few different types of melanomas, but the most common type is called superficial spreading melanoma.
What causes it?
Excessive sun exposure is the biggest risk factor.
Who should be screened for melanoma, and how often?
Clearly, someone with a family history or their own history of melanoma should be screened, but any light-skinned individuals living in the tropics for the long term, and anyone who works outdoors, should also consider consulting a dermatologist.
What types of screening procedures are available?
A dermatologist usually does a visual inspection, or an inspection with the aid of a lighted magnifier called a dermatoscope.
Say a melanoma lesion is found; at what stage is it potentially fatal?
All cancers progress through stages. Unless it’s treated, a Stage I melanoma will almost always progress to Stage II and so on.
What are the main treatment options, and how effective are they?
The treatment of melanoma is based on the stage it’s at. Early stage melanomas are very effectively treated by surgery, while late stage melanomas are treated with increasingly effective immunotherapy. Stage III melanomas are treated with a combination of surgery and systemic therapy, and Stage IV with chemotherapy or immunotherapy, or both.
The earlier melanoma is detected, the better the outcome of treatment. Survival greatly depends on the stage at which melanoma is identified. There’s a 95 percent five-year survival rate for someone whose melanoma is picked up at Stage I; if identified at Stage II this drops to about 70 percent; the figure at Stage III is about 60 percent; and by Stage IV it’s about 20 percent.
Are there any recent advances that have helped increase the accuracy of screenings and the effectiveness of treatments?
A diagnosis of melanoma is not as pessimistic as it was five years ago. That’s because of the rapid progress we’ve made in accurately identifying the stage of the cancer. What’s more, recent advances in the fields of sentinel lymph node localisation and immunotherapy for advanced disease have improved the outcome for patients.
Dennis Lim Surgery #11-09 Mount Elizabeth Medical Centre 3 Mount Elizabeth | 6836 5167 | dennislim.com.sg
#4 According to World Cancer Research Fund International, colorectal cancer is the third most common cancer in men and the second in women worldwide, with the highest rates found in more developed countries. The good news is that it’s preventable with screening options like colonoscopy, says gastroenterologist DR TAN CHI CHIU.
Procedure and prep
Under sedation, a colonoscope (a thin, flexible tube fitted with a camera and light guides) is inserted through the rectum and into the colon to detect any potentially cancerous polyps. For the endoscopist to see clearly, a patient must take some gentle laxatives prior to the examination (typically the evening before and morning of) to clear the bowels.
While there are other methods of screening for colon cancer, Dr Tan says colonoscopy is the all- around best technique. “A great advantage of endoscopy, including colonoscopy, is that, apart from direct visualisation, tiny surgical instruments can be passed through the endoscope to take biopsies, remove growths such as polyps, stop bleeding from lesions, insert stents ( devices that hold open blocked tubes) and other procedures,” says Dr Tan. “A ND-YAG laser or Argon Plasma fibre can also be passed down the endoscope to burn away cancers where appropriate or to coagulate bleeding blood vessels.”
Other detection methods may require a colonoscopy in any case – CT colonography, for instance. With CT colonography it’s harder to distinguish polyps from adherent lumps of faeces, as colour and texture are not well differentiated, says Dr Tan; such ambiguity will mandate a colonoscopy. “If colonoscopy were chosen in the first place, all would be clear, and biopsy or polyp removal could be done in one procedure. In addition, CT scans involve repeated exposure to high doses of radiation, which may increase the long-term risk of other cancers.” Scans can also prove more uncomfortable than colonoscopy done under sedation, due to the need to distend the colon with gas.
Other screening methods include examining the stool for traces of blood – for example, a Faecal Immunochemical Test (FIT). Though these tests aren’t as invasive, Dr Tan says they can have false positives and false negatives, and any positive test would lead to a colonoscopy anyway. There’s also the “yuck” factor with faecal samples, which studies have shown deter people from complying with screening.
“While the bowel preparation required for colonoscopy and the somewhat invasive nature of it are also deterrents,” says Dr Tan, “there is no test that’s as good for detecting polyps or cancer, both for the ability to directly visualise the entire lining of the colon as well as the ability to biopsy lesions and remove polyps at the same time.” In addition, safe and effective sedation, and modern, flexible endoscopes make the procedure comfortable.
Timing and risk factors
According to Dr Tan, some indications for colonoscopy include constipation, diarrhoea, or a combination of both, blood loss through the rectum, loss of appetite and/or unintended weight loss, general un-wellness and lethargy, and anaemia.
All adults with average risk are recommended to have a colonoscopy screening to detect potentially cancerous polyps or early colon cancer at the age of 50 or as soon as possible after, since the risk rises sharply around this age for the average person, explains Dr Tan. If the examination is normal or there are only minimal findings (a few, small benign polyps, for instance), the next interval screening can take place between five and 10 years later.
Dr Tan says that if there is a family history in first-degree relatives of colon polyps or cancer, it may be recommended to start colonoscopy screening earlier, such as age 40, or 10 years earlier than the age of the first-degree relative when significant polyps or colon cancer were found.
Gleneagles Hospital, 6A Napier Road 8111 9777 (Whatsapp) | gleneagles.com.sg/gut
#5 Gastric Cancer Screening
Much like colorectal cancer, gastric cancer is eminently curable – but only when detected early via endoscopic screening, says gastroenterologist DR ANDREA RAJNAKOVA. It begins when cancer cells start growing in the inner lining of the stomach, and usually develops slowly over many years.
How common is gastric cancer?
Though the incidence is decreasing worldwide, it remains the fourth leading cause of cancer death globally, according to World Health Organization (WHO), and the fifth most common malignancy worldwide, according to Globocan (International Agency for Research on Cancer) 2012. Traditionally, gastric cancer has a poor prognosis because of its late presentation. Early detection means better outcome, and endoscopy is the current standard diagnostic tool for gastric cancer.
What are the symptoms?
In the early stages, stomach cancer may cause indigestion, bloating after a meal, heartburn, slight nausea and loss of appetite. As stomach tumours grow, the symptoms worsen to include stomach pain, indigestion, loss of appetite, vomiting, weight loss, vomiting, fatigue, anaemia, blood in the stool and more.
How do you screen for gastric cancer?
Early gastric cancer can be very difficult to detect. In recent years, however, several new endoscopic imaging modalities have been developed. Once detected, anyone with signs of early gastric cancer needs to receive more targeted screening and be carefully monitored.
Who should go for it?
Singapore’s Gastric Cancer Epidemiology and Molecular Genetics Program (GCEP) identified five risk factors for the development of gastric cancer:
• Chinese males over 50;
• a family history of gastric cancer;
• Helicobacter pylori infection; • smoking;
• the presence of atrophy gastritis and intestinal metaplasia.
How is gastric cancer treated?
That depends on the stage, the site, and whether it has spread. Early gastric cancer can be removed through an endoscope and does not require surgery – much like colonoscopy. This technique was developed in Japan, where stomach cancer is often detected at early stages during screening. A deeper tumour will require surgery, often combined with chemotherapy or radiotherapy, or both. Once the cancer has spread to other organs, a cure is no longer possible.
Andrea’s Digestive, Colon, Liver and Gallbladder Clinic #12-10 Mt. Elizabeth Medical Centre, 3 Mount Elizabeth 6836 2776 | andrea-digestive-clinic.com