Uterine cancer is the fifth most common cancer in females and the most common cancer of the female genital tract in Australia, with about 3,300 cases annually and 660 deaths. The major prevalence is in women between 50 and 70 years, and the quoted major risk factors include: early onset menarche and late menopause, obesity, nulliparity, unopposed oestrogen treatments, polycystic ovaries with prolonged anovulation, extended use of tamoxifen for breast cancer treatment and Lynch syndrome, which confers a 30 % lifetime incidence. Presenting with abnormal PV bleeding or prolonged post-menopausal bleeding, other presentations may include dyspareunia, pelvic pressure, weight loss, anaemia and in later stages, possibly pelvic pain. Whilst a PAP smear will frequently be negative, pelvic imaging revealing a suspicious endometrium and subsequently hysteroscopy and biopsy guide the diagnosis. Patients with more than 50 % myometrial invasion have a six-to-seven-fold higher prevalence of pelvic lymph node metastases and advanced surgical stage compared with women with less than 50 % invasion. With current management the five-year survival has improved over the past 40 years to 83 %. 

In contrast to endometrial cancer, which has seen an increasing incidence since 1982 of about 0.9 % per year, Cervical cancer prevalence has reduced from 14 per 100,000 in 1982 to 7 per 100,000 in 2017, influenced by the introduction of the HPV vaccine Gardesil in 2007. Gardesil 9 is the HPV vaccine used in Australia’s National HPV Vaccination Program, providing 100 % protection against HPV strains 6,11,16,18,31,33,45,52 and 58, which are known to cause genital warts and cervical and other HPV -related cancers. Types 16 and 18 cause most of the HPV -associated cancers. This vaccine is recommended for all children aged 12 to 13 years and is free for all Australians aged 12 to 25 years. The vaccine is estimated to prevent up to 90% of cervical cancers and 96% of anal cancers.

I was fortunate in this podcast to have a conversation with Professor Thomas Jobling regarding the risks and management of endometrial and cervical cancer. Tom is a gynaecological oncologist, ex-AFL footballer and medical researcher with a very respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital.

Please welcome Professor Jobling to the podcast.

References :

Professor Tom Jobling: reception_tjobling@bigpond.com.au

Endometrial Cancer Treatment-NCI 

Endometrial Cancer-Cancer Australia