Current classification of malignant tumours in gynecological oncology – part II

Authors: B. Sehnal 1;  D. Driák 1 ;  E. Kmoníčková 2;  M. Dvorská 1;  M. Hósová 3;  K. Citterbart 1;  M. Halaška 1;  D. Kolařík 1
Authors‘ workplace: Gynekologicko-porodnická klinika, 1. LF UK a FN Na Bulovce, Praha, přednosta prof. MUDr. M. Halaška, DrSc. 1;  Ústav radiační onkologie, 1. LF UK a FN Na Bulovce, Praha, přednostka prof. MUDr. J. Abrahámová, DrSc. 2;  Patologicko-anatomické oddělení, 1. LF UK a FN Na Bulovce, Praha, primářka MUDr. K. Benková 3
Published in: Ceska Gynekol 2011; 76(5): 360-366


Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment.

Review article.

Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague.

Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. Over the years, these staging classifications - with the exception of cervical cancer and gestational trophoblastic neoplasia - have shifted from a clinical to a surgical-pathological basis. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes.

Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients’ outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one’s clinical experience to others for the comparison of treatment methods.

Key words:
staging, gynaecological oncology, FIGO, TNM.


1. Amendola, MA., Hricak, H., Mitchell, DG., et al. Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183. J Clin Oncol, 2005, 23, 30, p. 7454–7459.

2. Aoki, Y., Sasaki, M., Watanabe, M., et al. High-risk group in nodepositive patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Gynecol Oncol, 2000, 77, 2, p. 305–309.

3. Bell, SW., Kempson, RL., Hendricson, MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol, 1994, 18, 6, p. 535–558.

4. Benedetti-Panici, P., Maneschi, F., D’Andrea, G., et al. Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer, 2000, 88, 10, p. 2267–2274.

5. Boyle, P., la Vecchia, C.,Walker, A. Annual report on the results of treatment in gynecological cancer. twenty-fourth volume. J Epidemiol Biostat, 2001, 6, 1, p. 1–184.

6. Burghardt, E., Ostör, A., Fox, H. The new FIGO definition of cervical cancer stage IA: a critique. Gynecol Oncol, 1997, 65, 1, p. 1–5.

7. Cibula, D., Petruželka, L., et al. Onkogynekologie, 1. vyd. Praha: Grada, 2009, s. 393, 457, 489-494.

8. Clement, PB., Scully, RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol, 1990, 21, 4, p. 363-381.

9. Creasman, W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet, 2009, 105, p. 109.

10. de Oliveira, CF., Mota, F. Cervical cancer – pre-therapeutic investigations and clinical staging versus surgical staging. CME J Gynecol Oncol, 2001, 6, p. 246-256.

11. Delgado, G., Bundy, B., Zaino, R., et al. Prospective surgicalpathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix. A Gynecologic Oncology Group Study. Gynecol Oncol, 1990, 38, 3, p. 352–357.

12. Gallardo, A., Prat, J. Mullerian adenosarcoma of the uterus: A clinicopathologic and immunohistochemical study of 55 cases challenging the existence of adenofibroma. Am J Surg Pathol, 2009, 33, 2, p. 278–288.

13. Giuntoli, II RL., Metzinger, DS., DiMarco, CS., et al. Retrospective review of 208 patients eith leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol, 2003, 89, 3, p. 460-469.

14. Graflund, M., Sorbe, B., Karlsson, M. Immunohistochemical expression of p53, bcl-2, and p21(WAF1/CIP1) in early cervical carcinoma: correlation with clinical outcome. Int J Gynecol Cancer, 2002, 12, 3, p. 290–298.

15. Grigsby, PW., Siegel, BA., Dehdashti, F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol, 2001, 19, 17, p. 3745–3749.

16. Grigsby, PW. 4th International Cervical Cancer Conference: update on PET and cervical cancer. Gynecol Oncol, 2005, 99, 3, suppl. 1, p. 173–175.

17. Hong, JH., Tsai, CS., Lai, CH., et al. Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone. Int J Radiat Oncol Biol Phys, 2005, 63, 2, p. 492–499.

18. Horn, LC., Fischer, U., Raptis, G., et al. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol, 2007, 107, 2, p. 310–315.

19. Hricak, H., Gatsonis, C., Coakley, FV., et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation – ACRIN/GOG comparative study of diagnostic performace and interobserver variability. Radiology, 2003, 224, 3, p. 623–625.

20. Hricak, H. First open trial of the American College of Radiology Imaging Network: proper imaging approach for invasive cervical cancer. Radiology, 2002, 225, 3, p. 634–635.

21. Chang, KL., Crabtree, GS., Lim-Tan, SK., et al. Primary uterine endometrial stromal neoplasms. A clinicalpathologic study of 117 cases. Am J Surg Pathol, 1990, 14, 5, p. 415–438.

22. Cheng, X., Cai, S., Li, Z., et al. The prognosis of women with stage IB1-IIB node-positive cervical carcinoma after radical surgery. World J Surg Oncol, 2004, 18, 2, p. 47.

23. Kapp, DS., Shin, JY., Chan, JK. Prognostic factor and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer, 2008, 112, 4, p. 820–830.

24. Kawagoe, T., Kashimura, M., Matsuura, Y., et al. Clinical significance of tumor size in stage IB and II carcinoma of the uterine cervix. Int J Gynecol Cancer, 1999, 9, 5, p. 421–426.

25. Koivisto-Korander, R., Butzow, R., Koivisto, AM., Leminen, A. Clinical outcome and prognostic factors in 100 cases of uterine sarcomas: experience in Helsinki University Central Hospital 1990-2001. Gynecol Oncol, 2008, 111, 1, p. 74–81.

26. Kurihara, S., Oda, Y., Ohishi, Y., et al. Endometrial stromal sarcomas and related high-grade sarcomas: immunohistochemical and molecular genetic study of 31 cases. Am J Surg Pathol, 2008, 32, 8, p. 1228–1238.

27. Kurman, RJ. Blaustein’s pathology of the female genital tract. 5. ed. New York: Springer Verlag, 2002, p. 1391.

28. Major, FJ., Blessing, JA., Silverberg, SG., et al. Prognostic factors in early stage uterine sarcoma: A Gynecologic Oncology Group study. Cancer, 1993, 71, suppl. 4, p. 1702–1709.

29. Mitchell, DG., Snyder, B., Coakley, F., et al. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol, 2006, 24, 36, p. 5687–5694.

30. Narayan, K., McKenzie, AF., Hicks, RJ., et al. Relation between FIGO stage, primary tumor volume, and presence of lymph node metastases in cervical cancer patients referred for radiotherapy. Int J Gynecol Cancer, 2003, 13, 5, p. 657–663.

31. Pecorelli, S. 25th Annual report on the results of treatment in gynecological cancer. Int J Gynecol Obstet, 2003, 83, suppl. 1, p. 230.

32. Pecorelli, S. 26th Annual report on the results of treatment in gynecological cancer. Int J Gynecol Obstet, 2006, 95, suppl. 1, p. 258.

33. Pecorelli, S., Zigliani, L., Odicino, F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet, 2009, 105, p. 107–108.

34. Pecorelli, S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet, 2009, 105, p. 103–104.

35. Perez, CA., Grigsby, PW., Chao, KS., et al. Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys, 1998, 41, 2, p. 307–317.

36. Pettersson, F. Annual report on the results of treatment in gynecological cancer. FIGO, 1991, Twenty-first volume.

37. Piver, MS., Chung, WS. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol, 1975, 46, 5, p. 507–510.

38. Prat, J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet, 2009, 104, 3, p. 177–178.

39. Sakuragi, N., Satoh, C., Takeda, N., et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer, 1999, 85, 7, p. 547–554.

40. Tavassoli, FA., Devilee, P. World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organs. 1st ed. Lyon: IARC Press, 2003.

41. TNM klasifikace zhoubných novotvarů. 7. vyd. Chichester, UK: Wiley-Blackwell, 2009, česká verze 2011, s. 167–179.

42. Togashi, K., Morikawa, K., Kataoka, ML, Konishi, J. Cervical cancer. J Magn Reson Imaging, 1998, 8, 2, p. 391–397.

43. Tropé, C., Kristensen, G., Onsrud, M., Bosze, P. Controversies in cervical cancer staging. CME J. Gynecol Oncol, 2001, 6, p. 240–245.

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