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Thursday, 31 May 2012

Cancer of cervix Stage III

I recently had a young patient of 38 years who had been to see a doctor in Batam because she had bleeding after sexual intercourse for several months. The doctor did an examination, some tests and told her she was alright. Her husband was not convinced and brought her to see me. After a speculum examination it was almost certain that this young lady had a cancer of the cervix. An ultrasound scan showed a bulky mass in the cervix extending up to the uterus. I immediately oredered a CT scan and IVU to determine if there was spread to organs outside her cervix.I also did an examination under anaesthesia and a biopsy to confirm the cancer. It was a stage III cancer. Now this lady has a prognosis of 20-30% survival even after radiotherapy and chemotherapy.
Cancer of the cervix is a preventable condition. With the yearly PAP smears that most women have there is no reason why someone should end up with a stage III cancer. Cancer of the cervix used to be the number 2 cancer in women but no longer in todays context. What did this patient do wrong? Firstly she did not go for yearly check-ups, she did not do an HPV-DNA screen ( one cannot get cervical cancer without first contracting HPV a sexually transmitted virus) and she delayed seeing a doctor. Even though the recommendation for PAP smears is once in 2 years if you have a normal smear, it is prudent to do them yearly as a lot can happen in 2 years. Also an HPV screen which is now available can set our mind at ease if it is negative or make us more vigilant if it is positive. It is indeed a waste to see a young woman in this day with a cervical cancer stage III when this could have been prevented. Indeed, Singaporeans are now vaccinating themselves against  HPV.

Saturday, 5 May 2012

Why IVF(test tube baby) should not be the first option

As more Singaporeans delay having children, and the older married woman comes wanting the fastest way to get pregnant, many nowadays come to consult me with the idea that invitro fertilisation is the first line of treatment. I have to counsell them of course that IVF is actually the last resort! and should be so. Many in the course of the investigations and stepwise treatments will get pregnant before reaching the stage of IVF. Firstly, IVF is expensive and the results are not guaranteed as some women think. The results of IVF actually vary from 20-30% per cycle being lower the older the patient. And here's the main reason why women should not resort to IVF first, the incidence of abnormalities in offspring is significantly higher especially with ICSI (intracytoplasmic innoculation) and no one knows the real reason why. It may be related to increased risk of chromosome abnormalities or defects resulting from mechanical manipulation. Miscarriages are therefore significantly higher and this can be very traumatic psychologically.