Evolution of the endometrial cancer staging system. Challenges for Ukraine

Abstract

Endometrial cancer is a disease that is still among the top ten causes of mortality and morbidity in Ukraine today. More and more new data about this malignant neoplasm appear every day, which forces us to revise the approaches in the diagnosis and treatment of it. In June 2023, the International Federation of Gynecology and Obstetrics (FIGO) published the staging of endometrial cancer, which included new data obtained in recent years in the process of studying this pathology. It is important to note that the new review is significantly different from the previous one, because it is based not only on the anatomical spread of the tumor, but also on histological characteristics: lymphovascular invasion and its spread, differentiation and histological type of the tumor, invasion into the myometrium. Molecular classification was implemented, taking into account the new WHO edition of histological forms of tumors of the female reproductive system in 2020. The 2023 FIGO staging calls attention to the important role of the histologist in deciding the stage of endometrial cancer. This is one of the challenges for the gynecological oncology community, which will require a single protocol that would include the main histological aspects in the description of the tumor. It is also indicated the molecular profile of the tumor, which plays an important role in FIGO-2023 staging of endometrial cancer. Knowledge of the molecular profile of the tumor is importantly in the management of patients in the early stages of endometrial cancer, namely stages I and II. The presence or absence of certain markers of tumor aggressiveness can not only change the stage, but also lead to de-escalation of the patient’s treatment. Currently, there is a challenge of financial inaccessibility of the NGS (next generation sequencing) method, which is why this type of diagnosis is often avoided. This requires the search for new adapted algorithms for determining the molecular profile of a tumor, until the determination of POLEmut becomes more accessible to the Ukrainian community.

Keywords

• endometrial cancer
• molecular classification
• international federation of gynecology and obstetrics
• figo
• endometrial cancer staging
• lymphovascular invasion
• molecular profile