Pap smear – Mengapakah anda perlu ketahui ujian ini?

/in , /by

Apakah itu barah cervix, HPV dan apakah pemeriksaan yang disyorkan?

Apakah itu ujian Pap smear?

  • Pap smear (atau ujian Papanicolaou) adalah ujian yang dijalankan oleh doktor untuk mengesan tanda-tanda kanser (barah) cervix. Cervix adalah bahagian antara vagina dan rahim di dalam badan wanita (bahagian bawah rahim). 
  • Semasa ujian Pap smear, doktor tersebut akan memasuki sesuatu alat pemeriksaan bernama speculum yang digunakan untuk menolak tepi belah vagina. Setelah ditolak tepi, cervix dilihat dan sesuatu berus kecil digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan. 
  • Individu yang menjalani ujian Pap smear mungkin akan merasa kurang selesa tetapi biasanya tidak merasa sakit. 
  • Setelah ujian lengkap, sampel akan dihantar ke makmal untuk diperiksa di bawah mikroskope. 

Siapakah sesuai untuk menjalani ujian Pap smear?

  • Semua wanita yang berumur 25 tahun dan ke atas yang sudah aktif secara seksual sepatutnya menjalani ujian Pap smear. 
  • Bagi mereka yang tidak pernah mempunyai keputusan Pap smear yang tidak normal, Pap smear perlu dijalankan sekurang-kurangnya setiap 3 tahun. 

Apakah yang perlu disediakan sebelum wanita menjalani ujian Pap smear?

  • Tidak ada apa-apa yang spesifik yang perlu disediakan sebelum ujian Pap smear.
  • Wanita yang dalam haid juga boleh menjalani ujian ini. Jika haid terlalu berlebihan, individu tersebut boleh menghubungi klinik tersebeut untuk menukar tarikh temujanji.

Apakah itu barah atau kanser cervix?

  • Barah atau kanser cervix adalah barah ke-enam paling kerap antara wanita di Singapore. Barah cervix terjadi apabila sel-sel yang normal bertukar kepada sel yang tidak normal yang tumbuh diluar kawalan. Kebanyakan wanita yang mempunyai kanser cervix yang dikesan semasa peringkat awal boleh dirawat dengan sepenuhnya.
  • Faktor risiko barah cervix yang paling penting adalah jangkitan human papilloma virus (HPV).
  • Simptom-simptom barah cervix termasuk lelehan berdarah dari vagina yang berlaku di antara waktu haid (bukan semasa haid), selepas hubungan seks atau selepas menopaus.
  • Penyakit barah ini terbelah kepada beberapa peringkat (awal ke peringkat akhir). Barah ini boleh dirawat dalam beberapa cara termasuk pembedahan. Pembedahan termasuk “radical hysterectomy” atau pengeluaran cervix, rahim dan bahagian atas vagina atau pembedahan pengeluaran semua atau sebahagian daripada cervix – pembedahan ini boleh dilakukan dalam keadaan tertentu sahaja. 
  • Rawatan lain termasuk radiasi dan kemoterapi. 

 
Apakah itu human papillomavirus (HPV)?

  • HPV adalah virus yang boleh dijangkiti melalui sentuhan kulit, melalui hubungan seks (sama ada melalui vagina, oral atau lubang dubur) atau melalui sentuhan kawasan genital (alat kelamin). Individu tidak boleh dijangkiti HPV melalui sentuhan objek contohnya tempat duduk tandas. 
  • Disebabkan virus ini boleh dijangkiti melalui hubungan seks, jika individu mempunyai beberapa pasangan seksual, risikonya ditingkatkan. Tambahan pula, kondom hanya memberi perlindungan yang tidak sepenuhnya. Pengisapan rokok juga boleh meningkatkan risiko jangkitan HPV sebanyak 4 kali ganda, bersama juga jika individu mengambil ubat yang melemahkan sistem imun atau mempunyai penyakit yang melemahkan sistem imun. 

Adakah semua jenis atau strain HPV berbahaya?

  • Terdapat lebih daripada 100 strain atau jenis HPV tetapi kebanyakan jenis HPV tidak menyebabkan kanser. Lebih daripada 80% wanita akan terdedah kepada virus HPV dalam hidup mereka. Kebanyakannya, system imun badan akan menyingkirkan virus ini secara semula jadi sebelum virus ini menyebabkan penyakit teruk. Tetapi, peratusan kecil wanita akan menghidapi penyakit yang lebih serius seperti kanser. 
  • Terdapat jenis HPV yang berisiko rendah iaitu HPV jenis 6 dan 11 yang boleh menyebabkan penyakit ketuat kelamin (genital warts). Jenis berisiko rendah ini jarang sekali boleh menyebabkan kanser.
  • Antara jenis HPV yang berisiko tinggi adalah jenis 16 dan 18 yang boleh menyebabkan kanser cervix. Jenis 31, 33, 45, 52 dan 58 juga boleh menyebabkan kanser. 


Apakah ujian yang boleh dijalankan untuk mengesan HPV?

  • Ujian HPV boleh dilakukan pada masa yang sama dengan ujian Pap smear iaitu melalui pengunaan berus kecil yang digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan. 
  • Di clinic Dr Tan & Partners, kita dilengkapi dengan mesin yang boleh mendapatkan keputusan HPV secara cepat iaitu melalui Rapid HPV test. Keputusannya boleh dihasilkan dalam masa 24 jam. 

Apakah cara yang boleh mengurangkan risiko seseorang dijangkiti HPV dan barah cervix yang disebabkan oleh HPV?

  • Vaksin adalah efektif untuk mengurangkan risiko ini dan boleh mengelakkan seseorang daripada dijangkiti 70-90% jenis HPV berisiko tinggi dan juga jenis HPV yang boleh menyebabkan penyakit genital warts. Vaksin tersebut dinamakan Gardasil 9.
  • Selepas individu menerima vaksin, individu tersebut masih lagi perlu menjalani ujian Pap smear sekurang-kurangnya setiap 3 tahun kerana vaksin tidak boleh mencegahkan seseorang daripada dijangkiti jenis HPV berisiko tinggi yang lain yang tidak dilindungi Gardasil 9. 

Siapakah sesuai untuk menerima Gardasil 9?

  • Vaksin Gardasil 9 diluluskan untuk diberi kepada perempuan yang berumur 9 tahun ke 26 tahun. Bagi mereka yang berumur lebih daripada 26 tahun, penerimaan Gardasil 9 boleh dibincangkan bersama doktor. 


Apakah beza Gardasil 9 dengan vaksin HPV yang lain? 

  • Terdapat vaksin yang lain yang dinamakan Gardasil dan Cervarix. Gardasil hanya boleh mencegah jangkitan HPV jenis 6, 11, 16 dan 18 sahaja (16 dan 18 adalah jenis HPV yang berisiko tinggi) dan Cervarix hanya mencegah jangkitan jenis 16 dan 18 sahaja. 
  • Gardasil 9 boleh mencegah jangkitan HPV jenis 6, 11, 16, 18 dan juga jenis 31, 33, 45, 52 dan 58 (31, 33, 45, 52 dan 58 juga boleh menyebabkan barah cervix).

____________________________________________________________________________
Jika anda mengalami simptom-simptom yang disebut di atas dan ingin berjumpa dengan doktor wanita, sila hubungi klinik kita di Dr. Tan & Partners cawangan:
Dr. Tan & Partners @ DUO Galleria
7 Fraser St,
#B3-18 DUO Galleria (Bugis MRT), 
Singapore 189356
Nombor telefon +65 6976 5023
Dr. Tan & Partners @ Robertson
11 Unity St
#02-06/07 Robertson Walk
Singapore 237995
Nombor telefon +65 6238 7810
Klinik juga bersedia menerima pesakit tanpa membuat temu janji. 

5 Steps For Breast Self Examination

/in , /by

According to the statistics presented by the Singapore Cancer Society, Breast Cancer is the most commonly occurring cancer among women in Singapore. Each year, over 1,000 women are diagnosed with breast cancer, and over 400 die from the disease. 1 in 11 women will get breast cancer in their lifetime. The chances of surviving increases with early detection. 

What is Breast Cancer?

The female breast is made up of milk glands and ducts and is surrounded by a layer of fat. Breast cancer commonly develops within these milk ducts and glands. Breast cancer usually originates from the cells lining the milk ducts and glands. When breast cancer is detected at this non-invasive or in-situ stage, treatment is easier and patients have a higher chance of recovery.

5 Steps For Breast Self Examination


STEP 1: Stand in front of a mirror with your clothes removed, you should be able to see both your breasts clearly. Observe the breasts for signs of asymmetry, skin changes or nipple changes or any visible lumps.

STEP 2: Raise your hands behind your head and look for signs of abnormal skin or nipple changes, or any visible masses or lumps.

STEP 3: Observe your nipples for any abnormal nipple discharge. This may include bloody discharge, yellowish, watery or milk-ish discharge.

STEP 4: Lie down and use your right hand to feel your left breast. Using 3 fingers, gently palpate around the breast in a circular motion to palpate around each quadrant to feel for any palpable lumps.
Your hand should move outwards as you palpate in each quadrant. Your touch should be firm but smooth with an adequate amount of pressure. You should apply more pressure if you have dense breast tissue.
Make sure you feel the underarm area as well, palpating in the same circular motion to feel for any abnormal lumps. Repeat the same motion using your left hand for your right breast.

Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.


When to Perform Breast Self-Examination

Examine your breasts once a month – The best time to perform breast self-examination is about a week after your menstrual period starts.
If you no longer menstruate, do a breast self-examination the same day of each month, for example, the first of every month. Continue to perform a breast self-examination if you are pregnant, breastfeeding, or have breast implants.

All in All

Conducting a Breast Self-Exam (BSE) regularly can be an important way to detect Breast Cancer early. Early detection saves lives.
For a more reliable and accurate screening tool, consider getting a Breast Cancer Screening with a mammogram at our clinics. It can detect the presence of cancerous lumps even before they can be felt with the hand. 
If you are concerned about Breast Cancer, it is best to seek evaluation & screening early; you may call any of our clinics to arrange an appointment and our doctors will be more than glad to address your issue.
Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. 5 Ways to Fight Depression
  3. Mycoplasma Genitalium Infection (Uncommon STD)
  4. How Late Can a Period Be (Delayed Menstrual Cycle)
  5. What You Should Know about Intrauterine Device (IUD)
  6. 10 Causes of Abnormal Vaginal Lumps and Bumps
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  9. Why Do I Have Abnormal Vaginal Discharge
  10. What is HPV Vaccination – Gardasil 9

 

Cervical Cancer, Pap Smear & HPV Vaccination – What You Need To Know

/in , , , /by

What is Pap Smear?

Pap smear is a cervical cancer screening recommended every 3 years for all sexually active females starting from age 25 years old.

This is a quick, simple and painless procedure that can be done in the clinic and it only takes a few minutes.  A brush will be used to collect some cells from the neck of the womb (cervix) and it will be sent to the lab to identify any precancerous and cancerous cells.

Cervical Cancer

In Singapore, cervical cancer is the 3rd leading cause of cancer deaths in women age 15-44 years old.
Cervical cancer risk is increased with :

  1. Multiple sexual partners
  2. Human papillomavirus (HPV) infection
  3. Smoking
  4. Unprotected sex

What is Human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the commonest sexually transmitted infection. It can affect both men and women.
There are 2 types of HPV – the low risk and high-risk types.

  1. Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
  2. High-risk HPV plays a significant role in the increased risk of cancer, such as cancer of the cervix, vulva, and vagina in women as well as anal cancer in men who have sex with men (MSM)..

The American College Obstetrician and Gynaecologist (ACOG) strongly recommends co-testing using Pap smear and HPV DNA testing (high-risk HPV types) especially for women ages 30-65 years old.
Patients are advised to repeat these tests in 5 years if pap smear and HPV results are negative.
This allows patients to extend their screening interval.

However, for women who test positive for high-risk HPV types, this means their risk is increased and hence, may need to have Pap smear screening at a closer interval, i.e once a year and depending on the results of the pap smear, some may need a referral to a gynaecologist for early intervention.

Remember, women can have no symptoms with an abnormal pap smear and HPV infection. Hence, early detection and screening are crucial as early intervention can be life-saving. Symptoms such as bleeding and pain during sex (postcoital bleeding), bleeding in between periods, heavy vaginal bleeding, and bleeding after menopause are usually late signs of cervical cancer.

The good news is cervical cancer can be prevented through vaccination.

GARDASIL 9 is a vaccine that helps protect against Human Papillomavirus (HPV). Most people infected with HPV show no signs or symptoms, this means they can transmit the HPV virus to others without knowing it in any kind of sexual activity or skin to skin contact.

Gardasil 9 provides protection against 9 major strains of HPV, which includes HPV types 6,11,16,18,31,33,45, 52 and 58 which are responsible up to 90% of genital warts and cervical cancers or precancer changes.

The vaccine, however, does not treat the infection.

It can be given to both females and males from the age of 9 up to 45 years old.
From the age of 9-14 years, 2 doses 6 months apart is recommended while those age 15 onwards, 3 doses will be recommended according to the schedule of 0, 2 and 6 months.
The side effects post vaccination is usually mild and temporary including pain, swelling, bruising over injections site and very rarely may cause fever and nausea.
HPV vaccine reduces your risk significantly but it does not mean your risk becomes zero.

After the completion of HPV vaccination, all women who are sexually active and above the age of 25 should still undergo routine screening via pap smear.

If you are due for your routine PAP smear or if you have questions about cervical cancer screening & HPV vaccination and wish to find out more, please call or visit any of our clinics or drop us an email at hello@dtapclinic.com.sg
We have Female doctors at our Robertson Walk, & The DUO Galleria Branches Location. Call our clinic @ +65 6976 5023 

Take Care! 

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. Herpes – What You Need to Know
    7. The Good Wrinkles, Bad Wrinkles & the Ugly Wrinkles

9合1 加卫苗(Gardasil 9)疫苗

/in , , /by

9合1 加卫苗(Gardasil 9)疫苗可预防9种病毒株的人类乳头瘤病毒（HPV）所引起的癌症与疾病。
HPV是一种可分为两大类型的病毒，一组可致癌而另一组可致疣或乳头状瘤。
现今有超过一百种HPV病毒株并且每一株都有自己指定的数字，例如HPV16或HPV52。迄今为止，能致疣的HPV病毒株不会致癌而能致癌的病毒株并不会致疣！
HPV受诱惑于并仅活于体内的鳞状上皮细胞。这类细胞可存在于皮肤表面和潮湿的粘膜表面，例如：

  1. 阴道、肛门、子宫颈、外阴部（围绕阴道外）
  2. 阴茎的内包皮和尿道
  3. 内鼻、口、喉气管（主要呼吸管）和支气管（较小的呼吸管，分支于气管）
  4. 内眼睑

因此，这些表面的感染导致疣和癌细胞的形成。
9合1加卫苗有助于防止9种HPV病毒株的感染，因而适当的命名为9合1加卫苗。疫苗里的9种HPV病毒株当中，有2种用于预防疣（HPV16和18），而其余的7种用于预防癌症（HPV16、18、31、33、45、52与58）。
关于癌症，HPV是大多数宫颈癌、阴道癌、外阴癌、肛门癌、阴茎癌和口咽癌（咽喉癌和舌癌）病例的主要致癌病毒。

了解更多: 水货九价hpv疫苗-到底能够采取什么措施来避免接受

这个疫苗与旧款疫苗希瑞适（卉妍康 Cervarix）和4合1加卫苗（Gardasil 4）有什么区别？

与4合1加卫苗相比，9合1加卫苗对于HPV可提供更广泛的保护，它不仅能预防4合1加卫苗所预防的4种病毒株，它还能预防另外5种高危型的病毒株：HPV31、33、45、52合58。这几种病毒株加起来就已经覆盖了能导致百分之九十的宫颈癌病例的病毒株。
两种加卫苗都可预防致癌的HPV16、18，以及致疣的HPV6与11。
另一方面，希瑞适只针最常致癌的HPV16与18，而且并不能预防疣。

男女性都能接种9合1加卫苗吗？

是的，男女行都能接种9合1加卫苗，反观，希瑞适只适用于女性。

适合接种9合1加卫苗的最小年龄是？

9合1加卫苗可接种的最小年龄是9岁。在发生任何HPV接触之前接种疫苗是最有效的。

对女性而言，9合1加卫苗有多重要？

宫颈癌是新加坡15-44岁女性因癌症死亡的第三大主要原因，每月有6名妇女因宫劲癌而死。
通过疫苗接种可轻易预防宫颈癌，因此在女性当中受到了极大的推荐。
请记住，接种疫苗预防宫颈癌、阴道癌、外阴癌、肛门癌或口咽癌并不是百分之一百的有效的，但至少它现今提供了最好的预防机会，更何况，这些癌症还有其他致癌的HPV病毒株和其他致病因素。

对男性而言，9合1加卫苗又是如何重要？

首先，我们将根据不同的性行为进行两大分类：进行穿插性肛门性交的男性和不进行该行为的男性。
进行穿插性肛门性交并是接受一方的男性一般患上HPV相关肛门癌的风险较高，因HPV将贮藏于肛门粘膜表面。
无论往后的性取向如何，男孩或年轻男性进行早期接种疫苗都有助于预防肛门癌。与女性不同的是，进行肛门性交的男性目前尚无类似宫颈抹片实验（PAP Smear）这类受批准的筛查检测方案可实行。
不接受肛门性交的男性依然可从接种疫苗中受益。该疫苗可降低其口腔癌和阴茎癌的风险，因为在进行阴道性交或口交期间HPV可贮存于阴茎上，同样地，HPV也可在口交时贮存于口腔内。
许多异性恋男人可能会问：“HPV一般常导致宫颈癌，似乎更是个女性的问题而非是男性的。”仔细想想，HPV相关癌症对于女性是致命的，只要接种疫苗的男性人数越多，免疫人群就越大，从而降低把HPV传播给女性的风险。这被称为”“群体免疫力”。
相反，随着更多的女性接种疫苗，更多的男性就被赋予“群体免疫力”的保护，HPV流行率下降从而降低了感染HPV相关疾病的风险。
因此，我们也应该鼓励男性接种9合1加卫苗以降低HPV相关癌症和疣的总体风险和发生率。以澳洲为例，HPV疫苗接种已被纳入其国家免疫计划赞助的以学校为基础的举措，广泛接种12至13岁的男孩。

疫苗的使用方式和计量方案是什么？

医师将在您的胳膊、大腿或臀部肌肉上进行9合1加卫苗注射。
计量方案一共是3剂，在理想情况下，这3剂应在6个月内分散注射，例如：如果您今天已注射了第一剂，那么您的第二剂量将在2个月后注射，而第三剂将在第一剂的6个月后。
即使您忘记或延迟您的后续剂量，只要您在12个月以内完成所有3次剂量注射仍然可以实现有效的免疫力。

注射了9合1加卫苗后女性还需要进行宫颈抹片检查（PAP Smear）吗？

是的。虽然9合1加卫苗比旧款疫苗更覆盖了更多的HPV病毒株，但它仍然不能覆盖所有致癌的病毒株，而这其中就有7种。请记住，已知晓能导致癌症的HPV病毒株有15种，或许还有更多是我们还不知道的呢！
宫颈抹片检查应至少每三年进行一次，若您的检验异常，您的医师可能会建议您每6-12个月复查一次以便进行更密切的监测。
若您有意注射HPV疫苗或想了解更多相关信息，请联系我们在新加坡与马来西亚的诊所。
新加坡诊所
马来西亚诊所

Nose Cancer and Nose Cancer Screening

/in , /by

Nose Cancer and Nose Cancer Screening

What is Nose Cancer (Nasopharyngeal carcinoma)?

Nasopharyngeal carcinoma (NPC) is a cancer that arises from the back of the nasal cavity. It is more common in Asia than in Western countries.

What are the Signs and Symptoms of Nose Cancer?

What to look out for?
Common presenting complaints include:
• Block nose
• Headache
• Double vision
• Neck lumps and bumps
• Nosebleed
• Blood stained saliva
• Hearing loss

NPC can behave like a silent killer. One can be asymptomatic or showing no symptoms before experiencing symptoms.
Over time, the tumour can grow, ulcerate and invade into nearby structures leading to nerve involvement and other symptoms as stated above.
A tumour can also spread to distant spread to other parts of the body.

What are the risk factors for Nose Cancer?

  • Age and Gender
    It is a cancer that is more common in males.
    There is also a bimodal age presentation where occurrence peaks in younger and older adults.
  • Infective
    Epstein – Barr virus (EBV) infection
    The strong association between EBV infection and NPC is evident by anti-EBV antibody in the blood, an increased amount of EBV DNA levels in NPC tumour cells.
    This is why EBV antibodies are used in the clinical setting for the screening of Nose cancer.
    Human Papillomavirus (HPV) infection
    The role of HPV in NPC is less clear-cut in comparison to EBV in NPC but studies have shown that there might be an association with Nose Cancer.
  • Lifestyle
    Smoking
    There is postulation that smoking contributes to risks of NPC by causing reactivation of EBV.
    Even though there might not be sufficient evidence, smoking itself does cause many other diseases.
    Dietary practice
    Consuming preserved food which contains a high level of nitrosamines like salted fish, bacterial mutagens and EBV-reactivating substances is another risk of NPC.
    Some traditional Chinese medical herbs intake can lead to reactivation of EBV. 

Genetic Susceptibility
NPC has been associated with certain genetic predisposition and risks of NPC is increased in patients with first-degree relatives with NPC.

Nose Cancer Screening

  • History and Physical Examination.
    A thin camera also known as a flexible naso-endoscopy is useful for examination of the back of the nasal cavity and if needed, a tissue biopsy sample to be obtained at the same setting.
  • Future Tests include:
    Blood Tests
    A simple non-fasting screening blood test can be done to aid the detection of NPC.
    Given the close association between EBV and NPC, laboratory blood tests like EBV viral DNA and EBV IgA serology tests can be performed in the screening of NPC for patients belonging in high risks groups.
    Screening tests are recommended for patients who fall under the high risks group eg, those with positive family history.
    However, studies have also shown that early NPC being an indolent killer due to its relatively asymptomatic nature, has a higher 5-year survival rate when detected at an early stage. (see reference below)
    In addition, these tests can help to prognosticate treatment response and future recurrence of the same disease in patients diagnosed with NPC.
    Radiological
    Other imaging studies include magnetic resonance imaging (MRI) might be useful.

Treatment for Nose Cancer

Treatment options include radiotherapy, chemotherapy and surgery. Combined therapy of radiotherapy and chemotherapy together with surgery might be considered based on the location and extent of the lesion.

If you are interested in this service and wish to find out more, please call +65 6962 7144 or visit our clinic or drop us an email at hello@dtapclinic.com.sg.

Reference:
1 ) Chan, K. C. A., Woo, J. K. S., King, A., Zee, B. C. Y., Lam, W. K. J., Chan, S. L., … Lo, Y. M. D. (2017). Analysis of Plasma Epstein–Barr Virus DNA to screen for nasopharyngeal cancer. New England Journal of Medicine,378(10), 973-973. doi:10.1056/nejmx180004