Staging in Gynaecologic Oncology

This issue of Best Practice and Research Clinical Obstetrics and Gynaecology focuses on staging of gynaecological malignancies and provides an update on current thinking and developments. The text is arranged around site-specific cancers with a full chapter on the new International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube and peritoneal cancer and the rationale behind the changes made.

Further, the text interrogates the possibility of molecular staging and the significant strides that have been made in identifying and classifying the genetic abnormalities in ovarian and endometrial cancers. These genetic changes have enabled the recognition that the histological classification of the different cancers has less prognostic or predictive ability than genetic characterisation. Low- and high-grade cancers are now more accurately defined and may soon lead to different treatment choices.

New techniques for identifying sentinel nodes have been well established in vulvar cancer and are becoming important in cervical and endometrial cancer. Sentinel nodes used correctly can prevent the significant short- and long-term side effects of extensive lymphadenectomy and allow more tailored surgery. The role of lymphadenectomy in endometrial cancer remains controversial and not fully resolved, and this is discussed at length in the Endometrial Cancer chapter. The use of laparoscopy for staging of different types of gynaecological cancer is also extensively evaluated, as is the use of neoadjuvant chemotherapy and its implications for staging and prognosis.

Staging is part of understanding a complex set of features associated with cancer diagnosis and treatment, and it allows for the determination of the site of the disease, anatomical extent, histopathology, molecular and genetic profiles and subsequent investigation and management. Staging is important in prognosis, and also in determining whether curative or palliative treatment should be instituted.

At a population level, collecting good data on the types of cancer and stage of presentation is important to inform the development of national cancer control programmes. For instance, it is well established that cervical cancer incidence, stage at presentation and mortality are consistently very high in low- and middle-income countries, clearly indicating lack of early detection or prevention programmes. This information is critical for Ministries of Health to allocate resources appropriately. Staging also enables institutions, countries and regions to benchmark and compare results of treatment and to identify areas of inadequacy and inequity of access to resources.

This volume will provide the reader with comprehensive evidence-based staging, and cover a wide range of pertinent topics for appropriate care of women with gynaecological malignancies.