Revised FIGO staging for carcinoma of the cervix uteri

OBJECTIVE

To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent.

METHODS

Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations.

RESULTS

In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care.

CONCLUSION

The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.

The responsibility of gynecologists and obstetricians in providing safe abortion services within the limits of the law

Approximately 47 000 women die each year worldwide as a result of the complications of unsafe abortion, almost exclusively in low- and middle-income countries with restrictive abortion laws. In these countries, very few women who comply with the conditions imposed by the law can access safe abortion services in the public health system. The main obstacle is the unwillingness of gynecologists and obstetricians to provide abortion services by claiming conscientious objection, which is often used to hide their fear of the stigma associated with abortion. This happens because many colleagues are unaware that without access to legal services these women will resort to an unsafe abortion and its consequences. This violates the statement from FIGO's Committee for the Ethical Aspects of Human Reproduction and Women's Health, which asserts that: "The primary conscientious duty of obstetrician-gynecologists is at all times to treat, or provide benefit and prevent harm, to the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty."