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OBJECTIVE: Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague. RESULTS: Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. 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. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes. CONCLUSION: Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods.

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OBJECTIVE: Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague. Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague. Department of Pathology, University Hospital Na Bulovce, Prague. RESULTS: The main objectives of any good staging system--essential to an evidence-based approach to cancer--include planning treatment, providing an assessement of prognosis and the evaluation of the results of treatment. With this approach, the exchange of relevant information between oncological centers is facilitated, thus disseminating knowledge and stimulating research in other parts of the world. A good staging system must have three basic characteristics: validity, reliability, and practicality. The first staging system for gynaecological cancers appeared around the turn of the 20th century and was applied to carcinoma of the cervix uteri. Classifications for the other gynaecological malignancies were not created 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. Some changes, brought about through new findings, were approved by the FIGO in 2008 and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva, while others were made in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterine sarcomas, based on the criteria used in other soft tissue sarcomas. CONCLUSION: As a result of the explosion of medical research in the field of oncology, the staging of some of the gynaecological cancers became outdated and did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of a good staging system is to offer a classification of the extent of gynaecological cancer, in order to provide a method of conveying one's clinical experience to others for the comparison of different treatment methods.

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Two collectives of patients of the I. Gynecological-obstetrical clinic Praha/CSSR suffering from cervical cancer are examined after abdominal radical hysterectomy Wertheim-Meigs. Group 1 contained 125 women treated in the years 1957 to 1966, group 2 included 89 women undergoing the operation in the years 1981 to 1986. In group 2 we found a lower rate of perioperative injuries and early and late disturbances of the urinary tract following radical hysterectomy. This may be a result of more careful preparation of the ureter and intensive postoperative care. We examined 56 women of group 2 by urodynamics. There are statistical significant changes of the maximum urethral pressure and bladder compliance after the operation. This values returned to normal limits with increasing distance between operation and follow-up.

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PIP: Recently, IUd usage has increased, and with that increase has come an awareness of the undesirable side effects of the device, notably infection. Infection risks can be minimized if clinicians observe aseptic and sterile procedures. Histological studies were conducted on the tissues adhering to the IUDs of 244 women. The women were aged 20-40, and had had the IUD in place for an average of 4 years. Histological rather than bacteriological studies were conducted because the presence of bacteria does not necessarily indicate that disease is present. Secretory endometrium was found in 54.8% of the women, proliferative endometrium in 32.2%, cellular debris in 4.9% and stromoglandular disassociation in 8.1%. Of the 19 women in whom disease states were detected, endometritis chronica was seen in 79% of the cases, E. purulenta in 10.5%, e. acuta in 5.25% and E. subacuta in 5.25%. All of these conditions vanished after removal of the IUD and antibiotic treatment. In none of the cases was the IUD associated with precancerous atypia. Prevention may be the best approach with respect to infectuous complications associated with IUD use. Colposcopy, culturing of cervical mucus, PAP smears, erythrocyte sedimentation and leukocyte counts should be performed on women prior to IUD insertion. These steps guard against introducing vaginal infections into the uterus. When a woman comes to a physician complaining of pain in the lower back, abdomen, or during intercourse, infection must be suspected. If infection is found, treatment to eliminate the offending organism needs to be initiated. The woman's partner may also need to be treated.^ieng

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PIP: To determine relationship of long-term IUD retention and inflammatory disease of the internal genitals, 244 women who had an IUD in place for at least 4 years were studied. The IUDs were removed for research purposes an average of 7 days before the onset of menses. The material adhering to them was examined both to determine the stage of the menstrual cycle and to detect the presence of inflammatory infiltration of the endometrium. In 54.8% of the women the endometrium was found to be of the secretory type, in 32.2% of the proliferative type, while 8.1% had stromoglandular dissociation, and debris was found in 4.9% of the samples. In 19 women, inflammatory changes were found. 15 of these women were asymptomatic, but 4 suffered pain, discharge, and menstrual irregularity. In those women with inflammatory changes, 15(78.9%) had endometritis chronica modica, 2 had e. prurulenta, 1 e. subsacuta, and 1 e. acuta. Microscopic analysis of women with e. chronica modica showed presence of lymphocytes, leukocytes, fibroblasts and macrophages, but did not disclose plasmocytes. Endometrial biopsies were performed on 5 women with e. chronica modica in the cycle immediately following the removal of their IUDs. The finding of e. chronica modica did not persist in these women. It therefore seems that some women undergo a pseudoinflammatory process as an immune reaction of the epithelium to the IUD. Elevated leukocyte, lymphocyte, fibroblast and macrophage levels may be correlated with the contraceptive state. A true inflammatory process was seen in only 1.6% of the women studied, and the IUD can't be conclusively implicated as causing this inflammation. If proper precautionary measures are taken it appears safe to leave an IUD in place for at least 4 years.^ieng

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PIP: All the cases of inflammation complicating intrauterine contraception seen in a Prague clinic were studied in order to gain insight into the prevention and treatment of the condition. 2229 women were seen in the OB/GYN clinic. 1238 had an IUD, 462 were on hormonal contraceptives and formed the control group, and 524 were excluded from the study because they did not fit the study protocol. Inflammation occurred in 2.66% (33) of the women with IUDs and in 2.35% (11) of the control group. An analysis of the causes of inflammation revealed the following facts: at the average age of 28.5 (20-41) there is no difference in fertility or in work days lost between IUD users and the controls. Single or repeated IUD insertion does not figure in the incidence of inflammation. The proportion of IUDS with strings and without strings in those women who have inflammation is the same as in the general population. The onset of inflammation is most frequent at 3-6 months after insertion, but this difference may not be significant. Vaginitis with discharge, dominates the clinical picture in 85% of the IUD users with inflammation. Histological studied on 15 of these 33 women revealed endometritis. The risk of inflammation is correlated with increasing number of sexual partners. However, with proper medical care, inflammatory processes can be detected and arrested early.^ieng

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