Key changes include simplification of stage i disease and removal of cervical mucosal invasion as a distinct stage. Revised figo staging for carcinoma of the vulva, cervix, and. In europe, 1 to 2 in every 100 women will develop endometrial cancer at some point in their life. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. We need to continue to gain consensus internationally by having cross representation on our table 1 2014 figo ovarian, fallopian tube, and peritoneal cancer staging system and corresponding tnm. Radiation oncologyendometriumstaging wikibooks, open. The figo system is used to stage endometrial carcinoma, uterine carcinosarcoma and uterine sarcoma. Histologic grade grade 1, 2 vs grade 3 lymph node status stage 3 age at diagnosis race were all prognostic factors mortality higher. Figo committee on gynecologic oncology in 1988 and again revised. They both stage classify this cancer based on 3 factors. Figo staging classifications and clinical practice guidelines of gynaecologic cancers handbook on staging.
Major prognostic factors related to endometrial cancer are stage, grade, and depth of myometrialmi invasion and the presences of lymhovascular space invasion lvsi. The figo staging system recently underwent significant revision, which has important implications for radiologists. While lymphadenectomy is part of the current figo 2009 surgical staging for endometrial cancer, it is important for clinicians to consider the benefits, limitations and morbidity of the procedure in the absence of compelling evidence for any survival advantage related to full surgical staging. Figo in 1958 date back tothe end of the 1920s and the work carried. Figo committee on gynecologic oncology revised figo. Correct staging is a cornerstone in cancer treatment. Ovarian cancer, the revised figo staging system, and the role. Some early cancers may have signs and symptoms that can be noticed, but thats not always the case.
Abstract background stage iii or iva endometrial cancer carries a significant risk of systemic and locoregional recurrence. Imaging plays a central role in the 2018 international federation of gynecology and obstetrics staging system for uterine cervical cancer. Survival is generally very good for women who have lowgrade disease confined to the uterus. Endometrial cancer treatment pdqhealth professional. Jun 19, 2018 the national comprehensive cancer network nccn guidelines endorse universal immunohistochemistry ihc or microsatellite instability msi testing, regardless of family history, on all individuals diagnosed with colorectal or endometrial cancers to identify which patients should have genetic testing for lynch syndrome. Adjuvant chemotherapy plus radiation for locally advanced. The 2 mean age of diagnosis in the united states is 63 years 3.
This was a staging system based on clinical exam and it largely remains so today. Most doctors use the figo system to stage uterine cancer. Nonsurgical staging for endometrial cancer, where extrauterine disease exists, is inherently inaccurate, particularly in respect of small nodal involvement, intraperitoneal implants, and adnexal. The revised 2009 figo staging for endometrial cancer 2009 figo staging modifications the 4 main modifications to the 1998 figo staging criteria are as follows. Surgical staging of endometrial cancer replaced clinical staging by the. The most common staging system for uterine cancer is the figo system.
Figo staging for vulval and endometrial cancer was last amended in may 2009 and is now based on. Endometrial cancer early detection, diagnosis, and staging 1. The 2 systems used for staging endometrial cancer, the figo international federation of gynecology and. Endometrial cancer is the most common gynecologic malignancy in the united states, with yearly rates continuing to increase.
In the united states, endometrial cancer will be diagnosed in an estimated 54,870 women in 2015, with 10,170 succumbing to the disease. The purpose of this trial was to identify the sensitivity, false negative rate fnr and fn predictive value fnpv of sln compared to complete pelvic and paraaortic lymphadenectomy lad in women with highrisk ec. Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer. Changes in understanding of tumor biology led to a recent update in the figo staging system that reflects the variation in treatment strategies between endometrial and cervical cancer. Often the stages 1 to 4 are written as the roman numerals i, ii, iii and iv. The 2 systems used for staging endometrial cancer, the figo international federation of gynecology and obstetrics system and the american joint committee on cancer tnm staging system are basically the same. Positive peritoneal cytology is an independent riskfactor in early stage endometrial cancer.
Until now, the figo staging was based mainly on clinical examination with the addition of certain procedures that were allowed by figo to change the staging. Based on the risk factors identified in gog 33, a subgroup was identified in gog 99 as highintermediate risk. Endometrial cancer staging has changed over time to a surgicopathologic staging system. Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the united states. There have been 7 revisions since 1950 and the most recent changes occurred in 1994.
Endometrial cancer ec is the most common gynaecologic malignancy in developed countries and its incidence is increasing. Figo staging in vulval and endometrial cancer obstetrics and. Multiple risk factors are involved in the development of ec including obesity, unopposed oestrogen, early menarche and late menopause. Adc apparent diffusion coefficient, figo international federation of gynecology and obstetrics.
The major staging was done after a determination of whether the cancer was confined to the corpus or had spread beyond the corpus. In 2018, this has been revised by the figo gynecologic oncology committee to allow imaging and pathological findings, where available, to assign the stage. Definitive staging according to the figo system is based on surgical and pathology findings. For these types of uterine cancer, there are 4 stages. Endometrial carcinoma staging allows appropriate treatment options to be considered and enables greater prognostic accuracy for endometrial carcinoma. Incidence of endometrial cancer is on the rise with a lifetime risk of approximately 3%.
Revised figo staging for carcinoma of the vulva, cervix, and endometrium. Endometrial cancer is usually diagnosed at an early stage and can be treated with surgery. The last revision of the international federation of obstetricians and gynecologists figo staging of uterine corpus tumors was in 1988, and it represented the transition from a clinical to a surgicopathologic system. Its epidemiology, clinical management and new research into future treatments is addressed in figo s updated cancer report 2018, published in the. Sentinel lymph node sln mapping continues to evolve in the surgical staging of endometrial cancer ec. Staging for vaginal cancer is based on clinical evaluation according to the figo system. Cancer of the cervix uteri turk jinekolojik onkoloji. Your doctor or nurse might recommend testing for endometrial cancer if you have abnormal bleeding. Cervix uteri cancer staging 7th edition primary tumor t tnm figo categories stages tx primary tumor cannot be assessed cannot be assessedt0 no evidence of primary tumor tis carcinoma in situ preinvasive carcinoma t1 i cervical carcinoma confined to uterus extension to corpus should be disregarded. Significant changes have been made to the 2009 figo staging system for endometrial cancer, which has important implications for radiologists. Figo staging of carcinoma of the endometrium elearning. Carcinosarcomas mmmt should be staged as high grade carcinoma.
Endometrial cancer is a great concern in industrialized nations, where it is the most common gynecologic cancer with incidence increasing every year. Although each persons cancer is unique, cancers with similar stages. Cancer staging is a fundamental principle and one of the first and most important steps used to predict patient outcome as well as to plan the most appropriate treatment. Revised figo staging for endometrial carcinoma a pictorial. Endometrial cancer early detection, diagnosis, and staging cancer. Figo committee on gynecologic oncology revised figo staging for carcinoma of the vulva, cervix, and endometrium. Methods in this randomized phase 3 trial, we tested whether 6 months of p. Ovarian cancer, the revised figo staging system, and the. Myometrial invasion in the 1998 figo staging criteria, stage ia referred to disease within the endometrium, but with preservation of the junctional zone and no myometrial. The revised figo staging system for uterine malignancies. The most commonly adopted ovarian cancer staging system is the figo staging system. Endometrial cancer incidence has increased by around 50% in the united kingdom since. Figos staging classification for cancer of the ovary. I do hope that despitethe shortcomings a cancer staging inevitably has, we are indeed committed to provide better guidance to physicians involved in the.
Endometrial cancer is the most common cancer of the organs of the female reproductive system. Boronow the pelvic radiation was adequate to control whatever occult disease remained in the pelvis and that metastasis had not extended beyond the field of pelvic irradiation. Ovarian cancer staging radiology reference article. This staging now applies only to endometrial carcinomas and there is now a separate staging for uterine sarcomas. This system allows the use of chest radiographs, examination under anesthesia with bimanual and rectovaginal examination, cystoscopy andor proctoscopy in patients with urinary or rectal symptoms, and intravenous pyelogram to evaluate for hydronephrosis. We discuss treatment for endometrial cancer including chemotherapy, radiation, and hormones. Uterine cancer is the sixth most common cancer worldwide for females, and the 14th most common cancer overall, with more than 319,000 new cases diagnosed in 2012 5% of female cases and 2% of the total. The revision calls for a more precise measurement of primary tumor size, best assessed with imaging. History of endometrial cancer staging the early figo staging for endometrial cancer was adopted in 1950 and was used from approximately 19511961. A higher number, such as stage iv, means cancer has spread to other parts of the body.
Staging should be of benefit without significantly increasing morbidity. Sep 27, 2017 the international federation of obstetricians and gynecologists figo and the american joint committee on cancer ajcc have similar staging systems to define endometrial cancer shown. We present adjuvant therapy options for early endometrial cancer. Cancer staging is fundamentally important in treating patients with cancer. In 2009, the revised figo staging system was published 3. Tumor involves 1 or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the pelvis andor metastasis to the retroperitoneal lymph nodes old new iiia microscopic metastasis beyond the pelvis. Adapted from staging established by the international federation of gynecology and obstetrics figo and american joint committee on cancer ajcc, ajcc cancer staging manual, ed. Publication of this supplement was supported by figo funding to the figo committee for gynecologic oncology. Certain subgroups of early stage endometrial cancer have a high risk of recurrence. Am e ric an j o int co mmit te e o n can ce r cervix uteri. A test that is done in the office, called endometrial biopsy. In these cases, the clinical staging adopted by figo in 1971 would still apply, but designation of. Pdf the revised figo staging system for uterine malignancies. Since publication of the last figo cervical cancer staging in 2009, considerable progress has been made in the use of imaging modalities to evaluate women with cervical cancer.
Summary of recommendations clinical guidelines wiki cancer. Figo committee on gynecologic oncology revised figo staging. Cancer of the corpus uteri upper uterus, body of the uterus or uterine cancer is also generally referred to as endometrial cancer, because approximately 92% of cases affect the inner lining of the uterus. The international federation of gynecology and obstetrics figo ovarian cancer staging system was first published in 1973 and was revised in 1988 and 2014 1, 2. Jan 27, 2017 endometrial cancer is the most common gynecologic malignancy in the united states, with yearly rates continuing to increase. Endometrial cancer is the fourth most common cancer in women with an estimated 46,470 new diagnoses and over 8000 deaths in 2011. The new figo staging system for cancers of the vulva, cervix. In 1988, the international federation of gynecology and obstetrics figo cancer committee changed the staging of endometrial carcinoma from a clinical one to a surgicopathologic one. Controversies in the management of endometrial cancer 2012. The implication of such success is that staging of endometrial cancer r. International federation of gynecology and obstetrics. This cohort accounted for two thirds of recurrences and cancer related deaths. As a rule, the lower the number, the less the cancer has spread. Figo staging in vulval and endometrial cancer poliklinika harni.
Revision of figo surgical staging in 2009 for endometrial. The emphasis in the new figo system was changed to the pathologic findings in the uterus, cervix, adnexa, and pelvic andor periaortic nodes, and peritoneal. Analysis of 41,120 cases of endometrial cancer figo stage histological type clear cell, leiomyosarcoma, and carcinosarcoma were all found to have poorer prognosis. Cervix uteri cancer staging 7th edition primary tumor t tnm figo categories stages tx primary tumor cannot be assessed cannot be assessedt0 no evidence of primary tumor tis carcinoma in situ preinvasive carcinoma t1 i cervical carcinoma confined to. The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Figo staging system for endometrial cancer stage ii endometrial cancer in a 64yearold woman.
American joint committee on cancer staging manual, 7th edition, edge sb, byrd dr, compton cc, et al eds, springer, new york 2010. Staging is a way to describe the size of the cancer and whether it has spread to other parts of the body. Doctors assign the stage of endometrial cancer using the figo system. Vaginal brachytherapy2 or pelvic radiation therapy with or without concurrent chemotherapy followed by adjuvant chemotherapy3 stage iiib stage iiia stage ia no. In the european union, over 88,000 women are diagnosed with an endometrial cancer each year. The figo surgical staging for endometrial cancer was revised in 2009. International federation of gynecology and obstetrics figo. More than 70% of cases of 1 endometrial cancer are stage i at the time of diagnosis, when the reported 5year survival rate is 90%. Endometrial cancer early detection, diagnosis, and staging. The cancer is found only in the uterus or womb, and it has not spread to other parts of the body. Revised figo staging for carcinoma of the cervix uteri. The revised figo staging incorporates ovarian, fallopian tube, and peritoneal cancer into the same system. Doctors assign the stage of endometrial cancer using the figo.
Controversies with regard to cervical cancer staging are the following surgical versus clinical staging. Ct is considered the best imaging modality for staging ovarian cancer. It also spreads along the lymphatic channels to the regional lymph nodes. The first rules for classification and staging of female genital cancers adopted by the. It usually arises in postmenopausal women although 2025% of ecs are diagnosed before menopause. Ajcc 7th edition 2009 corresponds to updated figo staging 2009 figo 2009 pmid 19345353 revised figo staging for carcinoma of the endometrium. In some cases, imaging scans can show if the cancer has spread, but it is often not possible to be sure of the stage until after surgery. Sep 30, 2015 predictors of postoperative overall and severe complications after surgical treatment for endometrial cancer. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage i endometrial cancer lace. It is available for purchase now on amazon and is the most current version of the manual september 2018. The diagnosis of carcinoma is based on features indicative of invasion into the surrounding mesenchyma endometrial stroma or myometrium stromal invasion is typically seen in the form of glandular confluence and complex architecture. Figo to issue a revised staging system that can provide prognostic information and guidance on personalized management of ovarian cancer. The following is the consensus agreement that resulted from these efforts and represents new criteria for staging of these gynecologic cancer table 1.
Endometrial carcinoma staging radiology reference article. And within a stage, an earlier letter means a lower stage. Within the same figo stage, patients with disease involving multiple. Endometrial carcinoma figo staging system risk strati. Pdf cancers of the uterine corpus and cervix are the most common gynecologic malignancies worldwide. They constitute a very heterogeneous group of patients with varying risk factors yielding highly variable clinical outcomes. Predictors of postoperative overall and severe complications after surgical treatment for endometrial cancer.
For uterine cancer, the staging system developed by the international federation of obstetrics and gynecology figo is used. The ajcc cancer staging manual, eighth edition is the first edition to have the electronic book ebook version. The goal of staging is to have a clinical practice guideline which reduces inappropriate variation in clinical. Cancer of the corpus uteri, typically referred to as endometrial cancer, arises from the epithelial lining of the uterine cavity. Endometrial cancer stages range from stage i 1 through iv 4. A prospective validation study of sentinel lymph node. A test that is done as a day surgery, called hysteroscopy with dilation and curettage. This pathologic condition is staged with the international federation of gynecology and obstetrics figo system. The stage is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. The role of the fragility index january 2020 the impact of menstrual hygiene management on adolescent health. Mr imaging is the modality of choice for staging with ct having relatively low specificity especially for myometrial invasion 5. Sep 30, 2009 the international federation of gynecology and obstetrics figo, the first organization to develop a staging system of gynecologic cancer, became the official patron of the annual report for the development and changes of gynecologic cancer classification and staging since 1958. Its epidemiology, clinical management and new research into future treatments is addressed in figo s updated cancer report 2018, published in the international journal of gynecology and obstetrics. It was updated in 1988 and was most recently revised in 2009.