DOC DO I NEED TO GO FOR CANCER SCREENING 4

Cancer screening :

F.Cervical Cancer

Cervical Cancer is the sixth most common cancer in women in Singapore but can be prevented and treated early if regular screening is done.

Women who are at high risk of cervical cancer are those with:
1.sexual intercourse at an early stage

2.sexual intercourse with multiple partners

3.history of sexually transmitted infections

4.infection with certain high risk strains of human papilloma virus (HPV)

5.weakened immune system such as HIV infection

6.prolonged use of combined oral contraceptive (birth control)pills

Cancer screening procedures includes:
1.Pap smear test should be done yearly in women who has sexual intercourse or abnormal vaginal bleeding.
The Pap smear test involve a simple procedure in which the doctor obtains some scraping from the neck of the womb or cervix to detect abnormal cell changes.
Early detection of cancer of the cervix means early treatment and cure.
Patients who had HPV vaccination should also continue to go for regular Pap smear every 3 years

2.Yearly vaginal examination and pelvic examination which involve the Pap smear

G.Nasopharyngeal Cancer

Nasopharyngeal Cancer or NPC is a common cancer of the head and neck region especially common in Chinese men between the age of 40-65.

People who are at risk of developing Nasopharyngeal Cancer or NPC are:
1.family history of nasopharyngeal cancer -common in Chinese males, less so in other races and females

2.Viral infection of the nose-Epstein-Barr (EBV) virus has been shown to be present in most cases of nasopharyngeal cancer

3.Smoking with its 40 or more toxic chemicals in cigarette smoke can stimulate abnormal cells in the nose to mutate and become cancerous

Cancer screening procedures of nasopharyngeal cancer includes:
1.Blood test-tumor marker EBV. Blood is tested for raised level of EBV IgA antibodies against Viral Capsid Antigen(VCA) and Early Antigen).
Patients with raised EBV IgA antibody have a higher risk of developing NPC.
If these antibodies are seen to rise significantly, there is an indication of possibility of NPC in which case an endoscope examination of the upper nose and nasal biopsy can be done to exclude NPC.

VCA IgA test is more sensitive than EBV but remains high for 6 months following a viral upper respiratory tract infection.

EA IgA test is more specific in diagnosing NPC but the levels are also high in cancers of salivary glands, lung and stomach.

2.nasoendoscopy for patients with family history of of nasopharyngeal cancer or NPC.

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Image via Wikipedia

A TALE OF 2 CANCERS
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NASOPHAYNGEAL CANCER (A Simple Guide to Nasophayngeal Cancer)


The Ear Nose and Throat Department treats all cancers of the ear nose and throat.
Some of the throat and mouth cancers are treated together with the Dental Surgery Department.
In the 1970s one of the most common and deadly cancer was the Nasopharyngeal Cancer which  now is known to be linked with Epstein-Barr virus.
Treatment was difficult because of the closeness of the nose cancer to the brain and the frequently late diagnosis.
Surgical treatment is usually not considered unless it was at an early stage.
The treatment of choice was deep X-ray radiation to the affected area followed by chemotherapy in all cases spread of the cancer to other organs.
The mortality rate was high compared to the present modern treatment today of gamma knife treatment.
At the time of my assignment, there was a woman patient in the ward who was in the advanced stage of nasopharyngeal cancer and undergoing chemotherapy.
She was a teacher of 32 years of age who was mostly sick during the time there.
She was emaciated with vomiting during her chemotherapy and loss of appetite.
She was always in pain because the cancer has spread to the brain.
We had to give painkillers and anti-vomiting injections every now and then in order to relieve her symptoms.
Because of the injections, she was also in a sleepy state most of the time.
She has quite a few visitors including her family and her students, most of whom were dejected at the state of her condition.
I tried talking to her on several occasions but she was most too tired to answer except in short sentences.
One morning her bed was cleared and we know that she has succumbed to her illness in the night.


It was sad but quite a lot of nasopharyngeal cancer patients had succumbed in this way including my father-in-law during my medical student days.


LARYNGEAL CANCER (A Simple Guide to Laryngeal Cancer)


In contrast to the dangerous nasopharyngeal cancer (which was usually detected late), the Laryngeal Cancer is usually detected much earlier .
The symptom of hoarseness of voice was one of the easily symptom which prompts the patient to see a doctor.
Even then, some patient then to delay their checkup by a ENT surgeon preferring to see Chinese Sinsehs (Traditional Chinese healers) for treatment hoping to be cured of their condition.
We had a elderly female patient of 70 years who had an advanced stage of Laryngeal cancer which fortunately grow very much slower than the nasophayngeal cancer.
Although it had spread just outside of her larynx or vocal box, surgical removal of her cancer was successful.
A tracheostomy(hole in her windpipe) was done in order that she could breathe through the hole.
Her vocal box was completely removed and closed so her only way of breathing was through the hole.
By covering the hole partially ,she was able to utter some gutterial sounds which required a speech therapist to teach her to talk again.
Nowadays there are mechanical and electronic devices which can placed in the vocal box area to help the patient to talk
In the meantime she was recovering from her surgery in the ward.
Strict instructions was given to made sure the tracheostomy hole was not blocked and free of infection.
In the meantime I used to communicate with her through hand gestures and some written words.
She was cheerful in spite of her illness and I used to try to ‘talk’ to her with hand gestures and written words to keep her in good spirits.
Her relatives were also helpful and kind to her.
Once her condition was well enough to return home, she was discharged.


She even send me a thank you card for taking good care of her.
This was the one of the satisfying things about being a doctor.
It is always important to treat a patient well as another human being rather than a medical case.
When you treat a patient well and kindly , even other patients, nursing staff ,and hospital ‘amahs’(helpers or assistants) also know about it and treat you just as well.

In all, the ENT department was one of the satisfying department to work in and very essential to learn about managing a patient in the family practice.

Not many family doctors know how to remove a fish bone from the throat, a small marble from the nose of a child, remove wax from the ears, bleeding from the nose or treat peritonsillar abscess

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