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FIGO Staging: Gynaecological Oncology

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FIGO Staging: Gynaecological Oncology Andy Nordin Consultant Gynaecologist / Subspecialist Gynae Oncologist East Kent Gynaecological Oncology Centre, UK Hon. Senior Lecturer University College London National Lead for Gynaecology NHS Improvement – Cancer Chair: National Cancer Intelligence Network Gynaecology Clinical Reference Group
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Page 1: FIGO Staging: Gynaecological Oncology

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

Page 2: FIGO Staging: Gynaecological Oncology

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

Page 3: FIGO Staging: Gynaecological Oncology

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

Page 4: FIGO Staging: Gynaecological Oncology

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

2000

Page 5: FIGO Staging: Gynaecological Oncology
Page 6: FIGO Staging: Gynaecological Oncology
Page 7: FIGO Staging: Gynaecological Oncology
Page 8: FIGO Staging: Gynaecological Oncology

Which FIGO staging system

2000 (republished 2009)

OvaryFallopian TubeVagina

Trophoblastic Disease

2009CervixEndometrialVulva

Sarcoma

Page 9: FIGO Staging: Gynaecological Oncology
Page 10: FIGO Staging: Gynaecological Oncology

When will FIGO ovarian cancer staging change?

Page 11: FIGO Staging: Gynaecological Oncology

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

Page 12: FIGO Staging: Gynaecological Oncology
Page 13: FIGO Staging: Gynaecological Oncology

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

Page 14: FIGO Staging: Gynaecological Oncology

National Variation

Page 15: FIGO Staging: Gynaecological Oncology

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?


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