FIGO Staging:

Gynaecological Oncology

Andy NordinConsultant Gynaecologist / Subspecialist Gynae Oncologist

East Kent Gynaecological Oncology Centre, UKHon. Senior Lecturer University College LondonNational Lead for Gynaecology NHS Improvement – Cancer

Chair: National Cancer Intelligence Network Gynaecology Clinical Reference Group

FIGO Staging• why FIGO?• which FIGO?• Surgical vs Clinical staging• limitation of FIGO Cervical staging• MDT ascertainment of FIGO stage• national variation

1929: League of Nations Classification for Cervical Cancer Various refinements + uterine classification 1953: FIGO took responsibility 1961: first FIGO staging systems

First collaboration betweenFIGO: International Federation Gynecology & Obstetrics andIGCS: International Gynecologic Cancer Society

2000

Which FIGO staging system

2000 (republished 2009)

OvaryFallopian TubeVagina

Trophoblastic Disease

2009CervixEndometrialVulva

Sarcoma

When will FIGO ovarian cancer staging change?

Cervical Staging

Clinical FIGO Stage 1b ≠ TNM T1N0M0o 3cm tumour confined to cervix on imaging / EUA: FIGO stage 1B1 3 scenarios:o radical hysterectomy, negative nodes: FIGO stage 1B1, no adjuvant

treatment – 5 year survival 85%o radical hysterectomy, positive nodes: FIGO stage 1B1, adjuvant

chemoradiotherapy – 5 year survival 35-40%

o primary chemoradiotherapy: FIGO stage 1B1, unknown nodal status

Role of MDT in assigning FIGO stage

FIGO staging requires:• clinical findings• histology

• biopsy / primary surgery / staging procedures

• imaging• u/s, CT, MRI, PET

• surgical / operative findings• eg tumour > 2cm mets – may not be apparent on histo

may change as more information collected: definitive FIGO stage assigned by MDT at that time MUST be the one collected by registries

National Variation

Staging Data Cervix: variable

Ovary coverage limited to two ECRIC / NYCRIS

Uterine coverage limited to two ECRIC / NYCRIS

Questions: how are cases identified? how are ICD10 codes assigned? how / when is collected FIGO data generated? how can we ensure that MDT assigned FIGO stage is

collected nationally?