Cervical cancer staging
Cervical cancer staging is the assessment of cervical cancer to decide how far the disease has progressed. This is important for determining disease prognosis and treatment. Cancer staging generally runs from stage 0, which is pre-cancerous or non-invasive, to stage IV, in which the cancer has spread throughout a significant part of the body. Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system. Prior to the 2018 update, FIGO staging of cervical cancer allowed only the following diagnostic tests to be used in determining the stage: palpation (feeling with  the fingers), inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization. But with the 2018 update of FIGO staging of cervical cancer, imaging and pathology were added as allowable methods to assess disease stage. Overview of staging. FIGO guidelines suggest that lower staging should be assigned whenever possible. Staging is determined after all imaging and pathology reports have been collected and interpreted. The stage of cervical cancer cannot be altered at recurrence. Imaging. The use of imaging can provide more information regarding prognosis, which informs treatment. The  goal of staging is to identify the most appropriate treatment method and to minimize dual therapy, which can significantly impact morbidity. The imaging modality used for diagnosis should always be noted. Imaging modalities include ultrasound, MRI, CT, and positron emission tomography (PET). For primary tumors over 10 mm, MRI is the best method of radiologic assessment. For nodal metastasis over 10 mm, PET-CT is the most accurate modality for diagnosis, as this can differentiate large lymph nodes that are not metastatic (for example, those that are enlarged due to inflammation or infection) from lymph nodes that are enlarged due  to metastases. The diagnosis of nodal metastasis can be supplemented with surgical assessment via minimally invasive surgery or laparotomy to collect a biopsy or perform a fine needle aspiration. Pathology. As with imaging, pathologic methods used for diagnosis should always be noted for future evaluation. All cancers must be confirmed by microscopic examination. There are 10 histopathologic types of cervical cancers: Cancers can be histopathologically graded as follows: Sample collection. For microinvasive disease, clinicians should collect a specimen using a loop electrosurgical excision procedure (LEEP) or a cone biopsy. If a patient has a visible lesion, a punch biopsy may  be attempted. If the specimen is not satisfactory, a small loop biopsy or cone may be required. History of cervical cancer staging. The drive to develop a staging for gynecological malignancies, including cancer of the cervix, was the need to have a uniform method to describe the extent of the disease. Comparing outcomes from different treatments could only be possible if the comparison were made for groups of patients with a similar degree of disease burden. Major Historical Timepoints. 1929 - League of Nations Classification for Cervical Cancer 1937 - First annual report of statistics on radiotherapy outcomes in cervical cancer patients  1938 - Atlas of Cervical Cancer Staging (Heyman and Strandquist) 1950 - The International Classification of the Stages of Carcinoma of the Uterine Cervix 1954 - Founding of FIGO 1958 - FIGO becomes the official publisher of the Annual Report 1973 - Commencement of triennial publication of the Annual Report on the Results of Treatment in Gynecological Cancer 1976 - The American Joint Committee on Cancer accepts the FIGO stage grouping for gynecological cancers 2018 - Latest triennial FIGO Cancer Report The most recent updates to cervical cancer staging included in the 2018 edition marked a departure from a system based mainly on clinical evaluation to one  that allows imaging and pathological methods to help determine tumor size and extent of disease to assign the stage. A major topic of debate was the impact that newer diagnostic modalities would have on low- and middle-income countries, which bear most of the disease burden. The final recommendations make findings from imaging and pathology optional for staging rather than a requirement.