Ex­pert Voice:

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

Expat Living (Singapore) - - Contents -

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.

Cer­vi­cal can­cer

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.

What next?

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.”

Med­i­cal ex­am­i­na­tions

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 Colonoscopy

#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.

Colonoscopy’s ad­van­tages

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

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