Our Services Comprehensive Assessment of Cancers

Before treatment, all cancer patients should be comprehensively assessed. The objectives of the assessment are to determine the extent of the disease and the intent of the treatment.

Cervical Cancer

• After confirmation of the diagnosis, patients with cervical cancer should be clinically staged.
• For patients who are eligible for surgical treatment, MRI or PET/CT are useful for ruling out the involvement of surrounding structures as well as distant metastases. This is important because surgical treatment is usually not performed in patients with the disease not confined to the cervix.
• Patients who are not eligible for surgical treatment would normally undergo radiotherapy or chemoradiation. Therefore patients’ general status including fitness for treatment should be assessed.
• Basic investigations including tumour marker level should be performed.

Ovarian Cancer

• Sometimes diagnosis of ovarian cancer could not be made before operation. Therefore, comprehensive assessment should be conducted prior to operation.
• Investigations including basic blood tests, tumour marker levels and imaging studies are important pre-operative assessment, which would facilitate decision- making before operation.
• Patients should be assessed for the mode and the approach of operation, i.e. open laparotomy or minimally invasive operations with/without robotic assistance.
• The use of frozen section has its advantages and disadvantages. It should be discussed before operation.
• Not all patients would benefit from primary surgical debulking, and if operation is considered not feasible, neoadjuvant chemotherapy should be considered.

Endometrial cancer

• Basic blood tests, tumour marker levels and chest X-ray should be performed before operation.
• The grading of the tumour cells should be known before operation.
• Imaging studies can be considered as an additional assessment to assess the depth of invasion to the uterine wall and evidence of spread, if any.
• Patient should be assessed for the appropriate mode and approach of operation.

Vulval cancer

• Patients diagnosed with vulval cancer should be assessed for the mode of treatment depending on the extent of the disease.
• Basic blood tests, tumour marker levels and chest X-ray should be performed before operation.
• Surgery is the mainstay of treatment for most cases. The necessity for removal of lymph nodes depends on the depth of the cancer invasion and the size of the tumour.
• Imaging studies are very useful to pick up metastatic diseases.
• Primary surgical treatment may not be appropriate for locally advanced or metastatic diseases.

Vaginal Cancer

• Basic blood tests, tumour marker levels and chest X-ray should be performed before operation.
• Patients are required to be assessed for the mode of treatment depending on the site and size of the tumour.

Cancer of the fallopian tube and peritoneum

• Assessment is similar to that of the ovarian cancer.

Gestational trophoblastic neoplasia

• A series of workup has to be performed once a patient is diagnosed with gestational trophoblastic neoplasia. The purpose is to determine the stage of the disease and assign a risk score for the selection of chemotherapy regimen.
• This includes chest X-ray, ultrasound pelvis and abdomen, thyroid function test, serial human chorionic gonadotropin (hCG) level, baseline blood tests with/without CT scan.