STAGING OF GYNECOLOGIC MALIGNANCIES

The staging of patients with gynecologic malignancies is one of the fundamental aspects of their diagnostic path leading to the most appropriate treatment. Incomplete or inadequate staging often leads to an imprecise understanding of the clinical conditions of the patient and hence to inappropriate or incomplete therapeutic planning. The natural history of the tumor essentially defines the staging system, which is designed in steps (stages) to be usefully adopted by clinicians who are in charge of making the final decision in managing a patient with cancer; however, planning treatment for a given patient depends not only on the staging of the tumor, but also on the patient's characteristics to determine which treatment modalities will be best suited for that particular patient.

By staging a tumor, the clinician makes fundamental basic evaluations that can be drawn from the clinical, surgical, and imaging results obtained. Cancer staging needs to be clinically relevant, user friendly, evidence based, internationally agreed on, precise in the information provided, consistent with the current clinical practice, and provide prognostic information to achieve definition of:

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  The local extent of the tumor and the anatomical site of the primary tumor, as well as the extent of possible local invasion of adjacent tissues
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  Extent of regional spread
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  Extent of distant metastases

The accuracy of investigation reflects the precision of the staging, thus investing those scientific committees in charge of cancer staging classifications with the responsibility of providing the medical community with the standard practice guidelines to adequately perform staging.

Cancer staging should be based on the best available knowledge, which can be subject to changes deriving from new knowledge. Knowledge is achieved through the integration of new data and clinical research and needs to be spread by means of a common language and teaching.

The Committee on Gynecologic Oncology of the International Federation of Gynecology and Obstetrics (FIGO) is the internationally recognized official advisory body in charge of the definition of the staging criteria of all gynecologic malignancies. Since 1976 the FIGO classifications have been adopted by the American Joint Committee on Cancer, which has adopted the format used in the Annual Report on the Results of Treatment in Gynecologic Cancer (based on statistics provided by several institutions throughout the world on a voluntary basis), published every 3 years.

The present membership of the FIGO Committee on Gynecologic Oncology includes:

• J. Lou Benedet, Chair, Vancouver, Canada
• Hans Bender, Düsseldorf, Germany
• Howard Jones III, Nashville, TN, United States
• Hextan Y. S. Ngan, Hong Kong, People's Republic of China
• Sergio Pecorelli, Editor of the FIGO Annual Report, Milan, Italy

In clinical practice the FIGO nomenclature has replaced the TNM (T = extent of primary tumor; N = nodal metastasis status; M = distant metastasis status) modality of staging gynecologic malignancies. The American Joint Committee on Cancer and the Union Internationale Contre le Cancer, which formerly adopted the TNM system, agreed on working in close cooperation with FIGO to provide the medical community with a specific staging classification of cancer at gynecologic sites. Nevertheless, FIGO and TNM staging of malignant tumors are essentially the same with regard to categories and details (see relevant tables for each tumor site).