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?