Issues and inconsistencies in the revised gynecologic staging systems

In addition to acting as diagnosticians, surgical pathologists are increasingly becoming prognosticians. Currently there are 3 staging groups: the International Federation of Gynecology and Obstetrics (FIGO), the American Joint Commission on Cancer (AJCC), and the International Union against Cancer (UICC), each forming its own staging system. However, despite diligent efforts, these classification systems do not yet agree in their reporting of cancer staging. Because having a uniform set of staging guidelines is essential for consistent interpretation and management of patients with cancer, we attempt to review the issues and inconsistencies that exist in the current staging guidelines. Specifically, we compare and contrast the AJCC/UICC and the parallel system formulated by FIGO in the diagnosis of cancers in the gynecologic tract, focusing on the vulva, vagina, cervix, and endometrium/uterus. Our hopes are to clarify the controversies, because a more unified system must be created to eliminate ongoing inconsistencies, and to make communication and treatment even more reliable.