Changede Pradnya
Department of Obstetrics & Gynaecology, LTMMC & GH, Sion, Mumbai, Maharashtra India.
J Obstet Gynaecol India. 2024 Aug;74(4):378-381. doi: 10.1007/s13224-024-02054-9. Epub 2024 Aug 30.
In India, cervical cancer is the second most common cause of cancer-related fatalities and the fourth most common malignancy worldwide affecting women. India accounts for 25% of all cervical cancer-related deaths worldwide each year. The main drawbacks of clinical staging were the imprecise estimation of tumor size and the challenge of determining the involvement of pelvic and para-aortic lymph nodes with the few studies that FIGO allowed to be done for staging of cancer cervix. The use of 2009 staging approach showed that when many cases were operated based only on clinical findings, they subsequently required adjuvant therapy; hence, treatment-related morbidity was negatively impacted by these errors. Changes have been made to the staging of cervical cancer according to the 2018 revised International Federation of Gynecology and Obstetrics (FIGO) guidelines. Correction to cancer of the cervix staging was published recently in 2024. The horizontal extent (lateral extent) of the disease is not taken into consideration for staging in cases of microinvasive disease. Three subgroups have been identified based on the stratification of tumor size: IB1 ≤ 2 cm, IB2 > 2- ≤ 4 cm, and IB3 > 4 cm. Pathology and imaging modalities are added to clinical diagnosis for staging of cancer cervix. The involvement of lymph nodes (LNs) is now classified based on pathology (p) or imaging (r) which specifies that lymph node involvement is diagnosed using pathology (p) or imaging (r). Stage IIIC has been added [IIIC1 (involvement of pelvic nodes) and IIIC2 (involvement of para-aortic nodes)] is assigned to the case in the event of lymph node positive status. Pathological assessment takes precedence over radiological and clinical findings. The involvement of vascular/lymphatic spaces should not change the staging. The lower staging should be assigned when there is doubt about stage. Overall, the revised FIGO staging of cancer cervix (2024) has a number of advantages, including the inclusion of imaging and pathology, tumor size and LN-based categorization. More studies on staging of cancer cervix in different populations using revised staging of cancer cervix will help to prognosticate use of this staging.
在印度，宫颈癌是癌症相关死亡的第二大常见原因，也是全球影响女性的第四大常见恶性肿瘤。印度每年占全球所有宫颈癌相关死亡人数的25%。临床分期的主要缺点是肿瘤大小估计不准确，以及在国际妇产科联合会（FIGO）允许用于宫颈癌分期的少数研究中，确定盆腔和腹主动脉旁淋巴结受累情况存在挑战。采用2009年分期方法表明，当许多病例仅根据临床检查结果进行手术时，随后需要辅助治疗；因此，这些错误对治疗相关的发病率产生了负面影响。根据2018年修订的国际妇产科联合会（FIGO）指南，宫颈癌的分期已经做出了改变。宫颈癌分期的修正最近于2024年公布。对于微浸润性疾病，分期时不考虑疾病的横向范围（侧向范围）。根据肿瘤大小分层确定了三个亚组：IB1≤2cm，IB2＞2-≤4cm，以及IB3＞4cm。病理和影像学检查方法被纳入宫颈癌分期的临床诊断中。现在根据病理（p）或影像学（r）对淋巴结受累情况进行分类，这表明使用病理（p）或影像学（r）诊断淋巴结受累情况。如果淋巴结呈阳性状态，则将新增的IIIC期[IIIC1（盆腔淋巴结受累）和IIIC2（腹主动脉旁淋巴结受累）]分配给该病例。病理评估优先于放射学和临床检查结果。血管/淋巴管间隙受累不应改变分期。当对分期存在疑问时，应指定较低的分期。总体而言，修订后的FIGO宫颈癌分期（2024年）有许多优点，包括纳入了影像学和病理学、肿瘤大小以及基于淋巴结的分类。使用修订后的宫颈癌分期对不同人群的宫颈癌分期进行更多研究将有助于预测该分期的应用。
