FIGO Cancer Report 2018

The FIGO Committee for Gynecologic Oncology is pleased to present the third edition of the FIGO Cancer Report. Since 2012, this report has been presented triennially in the current format, which aims to present the state of the art management of gynecological cancers in our endeavor to ensure women worldwide receive an acceptable standard of care. The excellent readership of the previous edition encouraged us to produce an updated edition. A series of carefully reviewed and presented articles covers each of the gynecologic cancers. Chapters on pathology, targeted therapy, psychosexual health, and end-of-life care have been updated. New chapters have been added on surgical anatomy in gynecologic oncology, essential surgical skills for gynecologic oncologists, enhanced recovery after surgery, role of imaging in endometrial cancer, and cancer in pregnancy. This edition is Open Access to ensure wide dissemination. The 2015 edition of the Cancer Report was translated into Portuguese and Spanish, and the 2018 edition will also be translated to ensure greater readership. Undeniably, this does not do away with the need for data. The situational analysis done during the tenure of the previous committee had indicated the need to position dedicated data entry managers to get good quality data from low- and middle-income countries (LMICs). However, this project could not find funding. It is apparent that in these days of widespread internet use and mobile health, new methods will have to be found. The Committee initiated a survey to understand changing practices, the results of which will be presented at the XXII FIGO World Congress, held in Rio de Janeiro, Brazil, October 14–19, 2018. It is hoped that increased use of these techniques will bring more insights. In the last three years, FIGO Gynecologic Oncology Committee members have been actively engaged in organizing and participating in several educational activities including conferences, workshops, and training programs in various countries. They have developed educational aids including handbooks and slide sets. An e-learning course in collaboration with the Catalan Institute of Oncology (ICO) has been implemented. Cadaver training programs have been initiated for skills development in open and laparoscopic surgery. A smartphone mobile application (free to download and use ofline) for staging and resource-based management of gynecologic cancers was developed in collaboration with the International Atomic Energy Agency (IAEA).1, 2 One of the major objectives of the Committee has been to work with governments to inform policy regarding the implementation of the HPV vaccine program. Members have been engaged in advising various governments during this period. The Committee has collaborated with international and nongovernmental organizations to support this cause in different regions. By far one of the most challenging tasks undertaken by the Committee was the revision of the staging of cervical cancer. Hitherto staged by clinical methods only, it was insensitive to the advances in technology that had improved the quality of imaging and brought in minimally invasive surgery to facilitate access. However, being a disease largely confined to LMICs, there was widespread belief that a revision would not be applicable where it was needed most. Various rounds of discussions, extensive literature review, interaction, face-to-face meetings with the major gynecologic oncology societies internationally, in collaboration with the International Union for Cancer Control (UICC) and the American Joint Commission on Cancer (AJCC), finally resolved the impasse and the 2018 revision now allows the use of imaging and pathology in a way that can be practiced at all levels of resources. The revised staging has been endorsed by the FIGO Executive Board and will be published in the International Journal of Gynecology and Obstetrics (IJGO). The members of the FIGO Committee for Gynecologic Oncology during this term were: Neerja Bhatla (Chair), India; Kanishka Karunaratne (Co-Chair), Sri Lanka; Lynette Denny (Immediate Past Chair), South Africa; Seija Grenman (Vice President FIGO, Ex officio member), Finland; Jonathan Berek, USA; Mauricio Cuello Fredes, Chile; Sean Kehoe, UK; Ikuo Konishi, Japan; Alexander Olawaiye, USA; Jaime Prat, Spain; Rengaswamy Sankaranarayanan, France. Going forward, the Committee will continue its work on FIGO staging, the next cancer to be updated will be cancer of the vulva. FIGO also hopes to work closely with WHO in response to the call for elimination of cervical cancer. Collaboration with the International Agency for Research on Cancer (IARC) will help to gain insights on incidence and survival statistics from different regions to understand the inequities and direct our efforts to promote appropriate education and skills training as we work together to lessen the burden of gynecologic cancers.