Gynecologic cancers represent a significant cause of cancer-related deaths among women. Alarmingly, many early warning signs are frequently missed for extended periods, sometimes months or even years. By the time medical attention is sought, the crucial window for effective early intervention often narrows considerably.
Expert Insights on Early Detection
Professor Dr. Siriwan Tangjitgamol, a practicing gynecologic oncologist at MedPark Hospital in Bangkok, has dedicated her career to addressing this critical period. Her extensive training includes anatomical pathology, obstetrics and gynecology, and a postdoctoral fellowship in gynecologic medical oncology at The University of Texas MD Anderson Cancer Center. She is also the immediate past President of the Thai Gynecologic Cancer Society.
Dr. Tangjitgamol emphasizes the profound impact of her pathology background on her patient care approach. “The benefit of having knowledge about pathology first is that it supports you when you see a patient or any disorder,” she explains. “You can see it in a bird’s eye view, the whole thing altogether, not only a fragment of the abnormality.”
Understanding Gynecologic Subspecialties
While obstetrics and gynecology are widely recognized medical fields, they encompass three distinct subspecialties that are less commonly known: foetal-maternal medicine, reproductive medicine, and gynecologic oncology. Each requires specialized training beyond general qualifications.
Gynecologic oncology specifically focuses on the screening, diagnosis, and treatment of cancers affecting the female reproductive system. This includes cancers of the cervix, ovaries, uterus (including the endometrium), vulva, vagina, and fallopian tubes. This field demands a high level of both clinical and surgical expertise. In Thailand, the number of fully trained gynecologic oncologists is relatively limited compared to the patient population in need of their specialized care.
Advancements in Cervical Cancer Screening
Cervical cancer screening methods have undergone significant evolution over the past decade. The traditional method relied solely on cytology, commonly known as the Pap smear. Currently, primary HPV testing is the internationally recommended initial step, acknowledging that the Human Papillomavirus (HPV) is the direct cause of cervical cancer.
Unlike a standard Pap smear that detects abnormal cells, an HPV test identifies the virus before cellular abnormalities can develop. At MedPark Hospital, a co-testing approach is preferred, where both HPV and cytological tests are conducted simultaneously during a single visit.
“Generally, HPV testing is performed first, and if the result is abnormal, cytological testing is subsequently recommended,” Dr. Tangjitgamol notes. “This approach is consistent with both international and national population-based screening guidelines. However, for greater convenience and time-saving, we offer both HPV testing and cytological testing simultaneously for eligible women.”
While annual screening is the standard recommendation, women experiencing symptoms should not delay seeking medical attention. “In our hospital, if you have some doubtful lesion from the pelvic examination, you can do the ultrasound right away, and you can have an answer,” she states. If an HPV test is abnormal, the next step involves cytological testing. If further uncertainty remains, an ultrasound can be performed immediately during the consultation, eliminating the need for a separate appointment. Advanced imaging like MRI is also accessible on short notice when required.
Cultural Barriers and Patient Comfort
Hesitancy surrounding gynecological examinations is a common issue globally. In Thailand, this is often amplified by cultural factors. “This is a problem, especially for our Asian people, especially Thai people,” Dr. Tangjitgamol observes. “We are embarrassed. The woman’s part is very special, and in our culture, we are very shy.”
To address this, Dr. Tangjitgamol prioritizes building rapport with patients before any physical assessment. She begins by taking a comprehensive history, covering current symptoms, past medical history, and family history. The examination itself is tailored to each individual, with careful selection of instruments and continuous communication to ensure patient comfort.
“Every time, I try to accommodate them during the examination,” she says. “I inform them of each step of the procedure beforehand and continuously check for any pain or discomfort throughout the examination, to proceed at a pace they feel comfortable. No rush!” The Gynaecology Department at MedPark Hospital is designed with this patient-centric approach in mind, featuring adjustable hydraulic gynecological beds and an environment prioritizing privacy and minimal crowding.
Symptoms That Demand Attention
Abnormal vaginal discharge is the most frequent reason women consult a gynecologist, yet it is also one of the most commonly ignored symptoms. While most cases stem from infections or minor causes, discharge originating from cervical lesions, which could indicate pre-invasive or invasive cervical cancer, can appear deceptively similar.
“Chronic or foul-smelling discharge should not be dismissed as a simple infection,” Dr. Tangjitgamol warns. “Through a pelvic examination, doctors can identify potential abnormalities, detect cancer at an early stage, and initiate timely treatment.”
Beyond discharge, any symptom that persists without resolving warrants medical evaluation. Intermittent pain might have benign origins, but pain that continues for months without a clear explanation is a cause for concern.
“The woman will know herself that she should seek a doctor. But don’t trust yourself that much,” she advises. “Don’t trust the pharmacy or over-the-counter medication too much. If it doesn’t work, don’t be reluctant to seek an examination from a doctor.”
Since women cannot visually inspect their reproductive anatomy, professional examination is not merely a precaution but a necessity. “Let the doctor see it. If you have any symptoms, itching, a lump, a nodule, or whatever, the doctor will examine and tell you whether it is normal or abnormal.”
Family history plays a crucial role and requires ongoing attention. Dr. Tangjitgamol inquires about family history at every visit, as new diagnoses within a family can significantly alter the clinical picture and influence recommended screening or preventive care plans.
Navigating a Gynecologic Cancer Diagnosis
For women diagnosed with gynecologic cancer, the fear of the unknown can be as daunting as the diagnosis itself. A common misconception, particularly in advanced stages, is that treatment cannot yield meaningful results. However, the clinical reality offers more hope.
“Suitable treatment and care options are always available at any stage of the disease,” Dr. Tangjitgamol assures. “These are why patients should never lose hope.”
Care at MedPark Hospital is structured around a collaborative multidisciplinary approach. Specialists from various relevant fields consult on complex cases, share imaging results, and align on treatment strategies. Surgical interventions range from minimally invasive procedures to advanced techniques, including hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative MRI-guided surgery for cases demanding the highest precision.
A Crucial Message for All Women
When asked for a single, vital message for all women, Dr. Tangjitgamol’s response is unequivocal: “A regular checkup is very important. And don’t overlook or neglect abnormal symptoms. Go to see a doctor if you are not sure whether it is normal or abnormal.”
A regular checkup may not always involve extensive testing; sometimes, a straightforward pelvic examination is sufficient to confirm that everything is well or to detect an issue early enough for effective management. For cervical cancer screening, recommendations begin at age 25. For other gynecological cancers with a potential hereditary component, women with a positive family history are encouraged to consult a doctor for a personalized screening plan rather than waiting for symptoms to emerge.
Professor Dr. Siriwan Tangjitgamol sees patients at the Obstetrics and Gynaecology Clinic, located on the 7th floor, Counter D at MedPark Hospital. Her clinic hours are Mondays, Tuesdays, Wednesdays, and Sundays. Appointments can be scheduled directly through the MedPark Hospital website. The Obstetrics and Gynaecology Centre can be reached at 02-090-3135, with service available from 8 am to 8 pm.
