Gynecologic cancers are among the leading causes of cancer-related death in women, yet many of the earliest warning signs go unrecognised for months, sometimes years. By the time a woman seeks care, the window for early intervention has often already narrowed.
Prof. Dr Siriwan Tangjitgamol has spent her career working at exactly that window. An obstetrician-gynaecologist specialising in gynecologic oncology at MedPark Hospital in Bangkok, she trained in anatomical pathology at Siriraj Hospital before moving into obstetrics and gynaecology, then gynaecologic oncology at Vajira Hospital. She later completed 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.
That grounding in pathology, she says, changed the way she thinks about patients.
“The benefit of having knowledge about pathology first is that it supports you when you see a patient or any disorder. You can see it in a bird’s eye view, the whole thing altogether, not only a fragment of the abnormality.”
The three subspecialties women rarely know exist
Most people are aware that obstetrics and gynaecology exist as a field. Fewer know it contains three distinct subspecialties: foetal-maternal medicine, reproductive medicine, and gynecologic oncology, each requiring additional specialised training beyond the general qualification.
Gynecologic oncology covers the screening, diagnosis, and treatment of cancers affecting the female reproductive system, including cervical, ovarian, uterine including endometrial, vulvar, vaginal, and fallopian tube cancers. It is a field that demands both clinical and surgical expertise, and in Thailand, the number of fully trained gynecologic oncologists remains limited relative to the patient population that needs them.
How screening has changed and what MedPark now offers
Cervical cancer screening has shifted considerably over the past decade. The traditional approach relied on cytology alone, the familiar Pap smear. Today, primary HPV testing is the internationally recommended first step, given that HPV is the virus directly responsible for causing cervical cancer. Where a standard Pap smear looks for abnormal cells, an HPV test identifies the virus before those abnormal cells have a chance to develop.
At MedPark, both tests are preferably run simultaneously in a single visit, an approach known as co-testing.
“Generally, HPV testing is performed first, and if the result is abnormal, cytological testing is subsequently recommended. 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.”
Annual screening is the baseline recommendation. Women with symptoms should not wait for a scheduled appointment.
“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.”
If the HPV test returns abnormal, the process moves to cytological testing. If anything remains uncertain from there, an ultrasound is available immediately during the consultation rather than requiring a separate appointment weeks later. MRI and other imaging, if required, are similarly accessible on short notice.
Why Asian women, in particular, delay seeking care
Hesitancy around gynaecological examinations is common, and in Thailand, it is compounded by cultural factors that Prof. Dr Siriwan addresses directly.
“This is a problem, especially for our Asian people, especially Thai people. We are embarrassed. The woman’s part is very special, and in our culture, we are very shy.”
Her approach before any examination is to spend time with the patient first, taking a full history covering current symptoms, past medical history, and family history, before any physical assessment begins. The examination itself is adapted to each individual, with instrument selection based on the patient’s specific circumstances and continuous communication throughout.
“Every time, I try to accommodate them during the examination. 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 is designed with this in mind, using adjustable hydraulic gynaecological beds rather than traditional stirrup beds, in an environment built for privacy and minimal crowding.
The symptoms that should never be ignored
Vaginal discharge is the single most common reason women present to a gynaecologist, and it is also one of the most frequently dismissed. Most cases do involve infection or minor causes, but discharge originating from cervical lesions, which may indicate pre-invasive or invasive cervical cancer, can look deceptively similar.
“Chronic or foul-smelling discharge should not be dismissed as a simple infection. 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 rather than resolves deserves attention. Pain that comes and goes may have a benign cause, but pain that continues for months without explanation does not.
“The woman will know herself that she should seek a doctor. But don’t trust yourself that much. 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.”
Women cannot visually examine their own reproductive anatomy the way men can, which makes professional examination not 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 adds another layer of complexity. It is not a static piece of information collected once and filed away. Prof. Dr Siriwan asks about it at every visit, because new diagnoses within a family can change the clinical picture entirely and alter the recommended course of screening or preventive care.
What happens after a diagnosis
For women who receive a gynecologic cancer diagnosis, the fear of what comes next is often as overwhelming as the news itself. Many believe, particularly at advanced stages, that treatment cannot make a meaningful difference. The clinical reality is more encouraging than that assumption.
“Suitable treatment and care options are always available at any stage of the disease. These are why patients should never lose hope.”
Care at MedPark is structured around collaboration. Specialists across relevant disciplines consult on complex cases, share imaging results, and align on treatment approaches. Surgical options range from minimally invasive procedures to advanced interventions, including hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative MRI-guided surgery for cases requiring the highest level of precision.
One piece of advice
Asked what single message she would want every woman to hear, Prof. Dr Siriwan did not hesitate.
“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 does not always mean a battery of tests. Sometimes a straightforward pelvic examination is all that is needed to establish that everything is in order, or to catch something early enough that it remains manageable.
In regard to gynecologic oncology, Cervical cancer screening is recommended starting from the age of 25. For other gynaecological cancers which can be inherited in the family, women with a positive family history should consult a doctor to build a tailored screening plan rather than waiting for symptoms to appear.
Prof. Dr Siriwan Tangjitgamol sees patients at the Obstetrics and Gynaecology Clinic on the 7th floor, Counter D at MedPark Hospital, on Mondays, Tuesdays, Wednesdays, and Sundays. Appointments can be booked directly through the MedPark Hospital website.
The Obstetrics and Gynaecology Centre can be reached at 02-090-3135, available from 8am to 8pm.
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