The future role of molecular staging in gynecologic cancer.

Abstract

A cancer staging system should be explicit, practical, and should provide information required tomake important decisions about prognosis and treatment. The first FIGO staging nomenclatures for gynecologic cancers were based solely on the anatomical extent of the disease determined by physical examination and a few surgical parameters. As surgical evaluation of some gynecologic cancers became feasible, the FIGO staging system was revised to include surgical and histopathologic assessment of the tumor for most gynecologic cancers. Despite modifications in staging systems, the principles and purpose of cancer staging remain the same (Box 1). Identification of the cellular events leading to carcinogenesis provides additional information for comprehensive tumor classification and prognostication. While genetic sequencing was expensive and identifying driver mutations was laborious in the past, current technologies produce high-throughput data that makes methodical analysis of DNA, RNA, and proteins achievable. Genetic and molecular studies can be performed on blood and tumor samples obtained during the operative evaluation and treatment of cancer. A classification based on genomic and proteomic platforms is practical at this time, has minimal morbidity, and could provide essential information regarding prognosis and response to targeted therapies. The present article focuses on molecular discoveries that have been made in the last decade that should be considered in future revisions of gynecologic cancer staging systems.