No abstract

The main objectives of any good staging system - essential to an evidence-based approach to cancer - are: to aid the clinician in planning treatment; to provide indication of prognosis; to assist the physician in evaluating the results of treatment; to facilitate the exchange of information between treatment centers, thus disseminating knowledge; and to contribute to continuing investigations into human malignancies. A good staging system must have 3 basic characteristics: it must be valid, reliable, and practical. The first staging system for gynecological cancers appeared around the turn of the 20th century and applied to the carcinoma of the cervix uteri-the most common cancer affecting women in high income countries at that time. The classification and staging of the other gynecological malignancies was not put forward until the 1950s. Over the years, these staging classifications - with the exception of cervical cancer and gestational trophoblastic neoplasia - have shifted from a clinical to a surgical-pathological basis. This paper reviews the history of the International Federation of Gynecology and Obstetrics (FIGO) cancer staging system, how it was developed, and why.

Incidence, mortality and survival trends for the most frequent cancers affecting women are presented on a worldwide basis. Data sources are represented by several different cancer databases, as no single world cancer database covers these epidemiological measures. Monitoring cancer incidence, mortality and survival are fundamental indicators which allow estimates and predictions of geographical and temporal changes of these diseases, enabling the design and set-up of adequate cancer control activities and national health programs. The observed differences in cancer incidence, mortality and survival in more developed countries compared with less developed countries (as defined by WHO) are mainly due to different individual and social risk factors between the two geo-political areas. For some cancers, advancements in screening, diagnosis and treatment in the more developed areas were the most effective factors in reducing incidence and mortality as well as prolonging survival. These effects were not detected in the less developed areas because of the limited access to primary and specialist care.

Ovarian Cancer In both treatment and management of carcinoma of the ovary, a series of endpoints has been identified. Such endpoints are widely mentioned in the literature and will be analyzed in this chapter by following the guidelines suggested in the first part of this book, “Principles of Prognostic Factors.” Overall, the probability of cure of ovarian cancer is low, 41.6% 5‐year survival (Volume 23 of the FIGO Annual Report on the Results of Treatment in Gynecological Cancer ), even though in the last 20 years it has increased at least by one third. The improvement of overall survival thus represents the main objective of prospective clinical research, with study designs derived from the results obtained in other fields of clinical and basic research. The different prognostic factors are discussed according to their subdivision into essential, additional , and new and promising . Each of these factors will be cross‐referenced to tumor‐, host‐ and environment‐related characteristics, although some of them cannot be strictly classified under these specific categories. Prognostic factors will be dealt with in four different scenarios , chosen according to the importance they have in the management of this cancer.

No abstract