No Cancer Link With Cell Phone Towers

June 24, 2010 (London, United Kingdom) — There is no association between a pregnant mother's proximity to a cell phone tower and early childhood cancers, according to results of the largest study of its kind to date.

Paul Elliott, MD, PhD, professor of epidemiology and public health medicine from Imperial College, London, United Kingdom, led the research. The paper was published online June 22 in BMJ.

"We found no pattern to suggest that the children of mums living near a [cell phone tower] during pregnancy had a greater risk of developing cancer than those who lived elsewhere," Dr. Elliot told Medscape Oncology.

He added that unlike previous studies of associations between cancer and cell phone towers, this study used larger numbers of cases so was not subject to the selection and reporting biases seen with smaller sample sizes.

Case–Control Study

In this British study, data on nearly 1400 children younger than 4 years were drawn from the national cancer registry. All case subjects had leukemia or tumors of the central nervous system or brain from 1999 and 2001. Each child with cancer was matched with 3 control subjects for sex and date of birth from the national birth register.

The distance between registered address at time of birth and the nearest of 81,781 cell towers was assessed for each case. Likewise, total power output across all towers within 700 meters (765 yards) of the cell tower was recorded. The researchers then computed modeled power density at each birth address for towers within 1400 meters (1531 yards). Exposure beyond 1400 meters was considered to be at background levels.

This information was correlated with the incidence of cancers of the brain and central nervous system, leukemia, and non-Hodgkin's lymphomas, and all cancers combined.

In their paper, the authors acknowledge that despite low levels of exposure from cell phone towers, there are theoretical concerns about the effects on children because of the relatively greater dose (per kg body mass), the potentially greater susceptibility of children than of adults, and the potential effects of lifelong cumulative exposure to radiofrequency electromagnetic fields.

Only cancers with a short latency period, typically within the first 4 years of life, were investigated. In addition, the study was restricted to exposure of children in utero, although the authors state that postnatal exposure might be relevant to the incidence of early childhood cancers.

"We only looked at estimated exposures during the fetal period and were unable to look at exposure patterns for the children after birth. This is clearly a limitation and it would have been good to look at data after birth, if they had been available. However, our findings do not suggest any link between early childhood cancers and [cell phone tower] exposure," added Dr. Elliott.

Encourage Patients Not to Worry

In an accompanying editorial, John Bithell, MA, DPhil, honorary research fellow at the Childhood Cancer Research Group, University of Oxford, United Kingdom, points out that of the 3 surrogates of exposure considered in the study, the most convincing is the modeled power density at varying distances from the nearest tower. "This is probably the best measure used in an epidemiological study to date."

However, he adds that individual exposure could still vary substantially according to building design, lifestyle, and migration, so the prospects for good estimates of individual exposure are poor.

Based on these results, he concludes that the medical profession should encourage their patients not to worry about harm caused by proximity to cell phone towers. "The epidemiological evidence is also supported by experimental evidence, which has so far failed to show any biological effects — in vivo or in vitro — that might lead us to worry about the impact on health," concluded Dr. Bithell.

However, Sam Milham, Jr. MD, MPH, former chronic disease epidemiologist at the Washington State Department of Health and clinical associate professor at the University of Washington, School of Public Health, Seattle, believes the study used the wrong metric.

"All cell towers operate on direct current, which is changed from the grid alternating current (AC) by switching power supplies. These interrupt the AC current and create high-voltage transients, which get back into the grid. The transients are a potent carcinogen," he explained.

Dr. Milham, who was approached by Medscape Oncology for comment, is currently investigating a cluster of cancers in school teachers in Palm Springs, California. He explained the relation between distance from tower, transient levels, and cancer cases.

"It has a cell tower 20 feet from a classroom wing. The transient levels in the classrooms are inversely related to distance from the tower base, and the cancer cases are found to be overrepresented in the rooms near the tower. This is a close-in phenomenon. I also find very high transient levels in firehouses and businesses near cell towers."

"The BMJ study's high-dose group, by distance, was under 612 meters [669 yards]. If they can show me that the case–control risks were similar for residences less than 100 and 200 meters [109 and 218 yards, respectively] from the tower, I'll accept their findings," Dr. Milham said.

The study was funded through the UK Mobile Telecommunications Health Research (MTHR) Programme, an independent body set up to provide funding for research into the possible health effects of mobile telecommunications. The MTHR is jointly funded by the UK Department of Health and the mobile telecommunications industry. Dr. Elliott and Dr. Milham have disclosed no relevant financial relationships. Dr. Bithell reports a beneficial interest in shares in Vodafone Group not exceeding £3000 in value.

How Does the San Francisco Syncope Rule Perform in Canada?

How Does the San Francisco Syncope Rule Perform in Canada?
The rule had a sensitivity of 90% for predicting serious outcomes at 30 days

Patients with syncope often are admitted to the hospital despite negative
emergency department (ED) evaluations. The San Francisco Syncope Rule was
developed to identify syncope patients who are at sufficiently low risk for
serious outcomes to be safely discharged home after ED evaluation. The rule
classifies patients as high risk if they have histories of congestive heart
failure, hematocrit <30%,>
or triage systolic blood pressure <90>
to have 96% and 98% sensitivity for predicting serious outcomes at 7 days
and 30 days, respectively, but has not performed as well in subsequent
validation studies in the U.S. and Australia, where sensitivities ranged
from 74% to 90% (JW Emerg Med Sep 19 2008 and JW Emerg Med Jun 8 2007).

To evaluate performance of the rule in Canada, researchers retrospectively
applied the rule to 505 patients who presented to a single tertiary care
hospital with syncope during an 18-month period. Serious outcomes were
defined as death, myocardial infarction, arrhythmia, pulmonary embolism,
stroke, subarachnoid hemorrhage, significant bleeding, any procedural
intervention to treat a related cause of syncope, any condition causing or
likely to cause a return emergency visit, and hospitalization for a related
event. Overall, 9.7% of patients had serious outcomes within 30 days. The
rule had a sensitivity of 90% for predicting these outcomes.

Comment: The results of this study are consistent with those from other
validation studies. The San Francisco Syncope Rule will likely need to be
improved and then validated before it is adopted in practice. Until then,
clinical judgment should continue to guide treatment and disposition.

— Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine

SOUTH AFRICAN DOCTOR INVENTS FEMALE CONDOMS WITH "TEETH" TO FIGHT RAPE

South African doctor invents female condoms with 'teeth' to fight rape

Dr. Sonnet Ehlers was on call one night four decades ago when a devastated rape victim walked in. Her eyes were lifeless; she was like a breathing corpse. "She looked at me and said, 'If only I had teeth down there,'" recalled Ehlers, who was a 20-year-old medical researcher at the time. "I promised her I'd do something to help people like her one day." Forty years later, Rape-aXe was born. Ehlers is distributing the female condoms in the various South African cities where the World Cup soccer games are taking place. The woman inserts the latex condom like a tampon. Jagged rows of teeth-like hooks line its inside and attach on a man's penis during penetration, Ehlers said.

Once it lodges, only a doctor can remove it -- a procedure Ehlers hopes will be done with authorities on standby to make an arrest. "It hurts, he cannot pee and walk when it's on," she said. "If he tries to remove it, it will clasp even tighter... however, it doesn't break the skin, and there's no danger of fluid exposure." Ehlers said she sold her house and car to launch the project, and she planned to distribute 30,000 free devices under supervision during the World Cup period. "I consulted engineers, gynecologists and psychologists to help in the design and make sure it was safe," she said.

After the trial period, they'll be available for about $2 a piece. She hopes the women will report back to her. "The ideal situation would be for a woman to wear this when she's going out on some kind of blind date ... or to an area she's not comfortable with," she said. The mother of two daughters said she visited prisons and talked to convicted rapists to find out whether such a device would have made them rethink their actions. Some said it would have, Ehlers said.

Critics say the female condom is not a long-term solution and makes women vulnerable to more violence from men trapped by the device. It's also a form of "enslavement," said Victoria Kajja, a fellow for the Centers for Disease Control and Prevention in the east African country of Uganda. "The fears surrounding the victim, the act of wearing the condom in anticipation of being assaulted all represent enslavement that no woman should be subjected to." Kajja said the device constantly reminds women of their vulnerability. "It not only presents the victim with a false sense of security, but psychological trauma," she added. "It also does not help with the psychological problems that manifest after assaults."

However, its one advantage is it allows justice to be served, she said. Various rights organizations that work in South Africa declined to comment, including Human Rights Watch and Care International. South Africa has one of the highest rape rates in the world, Human Rights Watch says on its website. A 2009 report by the nation's Medical Research Council found that 28 percent of men surveyed had raped a woman or girl, with one in 20 saying they had raped in the past year, according to Human Rights Watch.

In most African countries, rape convictions are not common. Affected women don't get immediate access to medical care, and DNA tests to provide evidence are unaffordable. "Women and girls who experience these violations are denied justice, factors that contribute to the normalization of rape and violence in South African society," Human Rights Watch says.

Women take drastic measures to prevent rape in South Africa, Ehlers said, with some wearing extra tight biker shorts and others inserting razor blades wrapped in sponges in their private parts. Critics have accused her of developing a medieval device to fight rape. "Yes, my device may be a medieval, but it's for a medieval deed that has been around for decades," she said. "I believe something's got to be done ... and this will make some men rethink before they assault a woman."

Jadilah Pasien Pintar! (In Bahasa Indonesia)

Jadilah Pasien Pintar!


Salah satu sebab mengapa orang enggan pergi ke dokter atau rumah sakit, bisa jadi karena persoalan komunikasi. Hal ini diungkapkan guru besar Fakultas Kedokteran Universitas Indonesia, Prof. Daldiyono Hardjodisastro, dalam bukunya yang berjudul Pasien Pintar dan Dokter Bijak.

Dalam buku tersebut diungkapkan, untuk mendapat hasil maksimal dari pertemuan dengan dokter, pasien harus mempersiapkan diri, di antaranya:

* Mengenakan pakaian yang memudahkan dokter melakukan pemeriksaan.

* Mencatat keluhan yang hendak disampaikan ke dokter secara lengkap, kapan dirasakan, dan upaya yang sudah dilakukan untuk mengurangi rasa sakit. Beritahukan pula penyakit yang pernah atau sedang diderita, obat yang sedang diminum, serta jika ada alergi.

* Dari tanya jawab soal keluhan dan pemeriksaan fisik pasien, dokter akan menegakkan diagnosis kemudian memberikan terapi, termasuk resep obat. Pasien berhak mendapat informasi yang jelas mengenai hasil pemeriksaan, menanyakan bila ada yang belum jelas, juga mengambil keputusan untuk menerima atau menolak saran dokter tentang terapi yang akan diberikan. Jika pasien tidak menerima keputusan dokter, ia berhak mencari pendapat kedua (second opinion) dari dokter lain.

* Pasien yang pintar perlu bertanya dan mengetahui obat apa yang diresepkan dokter serta manfaatnya.

* Jika kondisi keuangan tidak memungkinkan, pasien perlu meminta obat generik. Hilangkan persepsi bahwa penyakit harus cepat sembuh. Ingat, pengobatan memerlukan waktu, kesabaran, dan ketekunan. Tak jarang, ada dokter terbawa kemauan pasien yang ingin cepat sembuh, sehingga melakukan berbagai jenis pemeriksaan yang belum tentu diperlukan atau memberi obat berlebihan.

* Sebaliknya, dokter yang bijak adalah yang mampu berkomunikasi secara efektif dengan pasien. Dokter mau mendengarkan keluhan pasien, menjawab pertanyaan dan menjelaskan situasi pasien, memberi nasihat cukup, serta tidak sekadar memberi resep, sehingga pasien merasa puas.

* Kemampuan berkomunikasi merupakan inti dari pekerjaan dokter. Kepandaian sebenarnya hanya nomor dua. Pasalnya, 60 persen pasien sebenarnya tidak sakit, tetapi mengalami kelainan fungsional. Hanya 40 persen yang benar-benar sakit, itu pun 20 persennya akan sembuh sendiri.

Lalu, bagaimana menghadapi dokter yang tidak komunikatif? Konsultan gastroenterologi-hepatolog

i ini menyarankan untuk meninggalkan ruangan dan segera pindah dokter jika memungkinkan.

Jika Merasa Tak Puas

Pernah dikecewakan oleh pelayanan di rumah sakit? Agar keluhan Anda tersampaikan dengan baik, berikut beberapa caranya:

* Jika mempunyai keluhan, catat dengan jelas tanggal, hari, dan jam kejadian, kalau perlu nama petugas yang memberikan pelayanan. Kemudian Anda dapat menghubungi bagian humas maupun customer service rumah sakit tersebut.

* Ada rumah sakit yang kepala perawatannya bertugas mengurus masalah atau keluhan, sehingga pasien disarankan menghubungi Kepala (Bidang) Perawatan bila merasa tidak puas. Bila masalah belum terpecahkan, tidak tertutup kemungkinan langsung maju ke direktur atau pimpinan rumah sakit.

* Anda dapat menghubungi perwakilan Persatuan Rumah Sakit Seluruh Indonesia setempat. Persi mempunyai kepengurusan di semua wilayah di seluruh provinsi di Indonesia.

* Manfaatkan kotak saran yang ada di setiap rumah sakit untuk mengomunikasikan hal-hal yang dianggap pasien (konsumen) tidak patut dilakukan oleh petugas rumah sakit. Hal ini merupakan masukan positif agar pihak rumah sakit memperbaiki diri. Tanpa masukan dari konsumen, pengelola rumah sakit akan selalu merasa bahwa pelayanan yang diberikan sudah cukup baik. Jadi, masukan atau kritik harusnya diterima sebagai satu mekanisme kontrol dari pengguna jasa rumah sakit.

* Jika merasa tidak puas dengan layanan dokter, konsumen dapat langsung mengklarifikasi dengan dokter yang merawat terlebih dahulu. Termasuk adanya dugaan kesalahan prosedur layanan (obat, dosis, maupun tindakan).

* Sangat tidak dibenarkan bila sewaktu pasien melakukan klarifikasi, dokter tidak melayani dengan baik, misalnya menghindar atau mengaku tidak punya waktu. Seorang dokter yang memberikan layanan kepada pasien sudah terikat satu kontrak, yang dikenal dengan kontrak terapeutik (Prof. Dr. Leenen), sehingga dokter bersangkutan harus memberikan penjelasan atas setiap pertanyaan pasien. Sikap profesional harus dijaga oleh para dokter.

* Pahami hak pasien, salah satunya mendapatkan informasi yang jelas dan benar. Pergunakan hak itu dengan baik, beritahu dokter bahwa Anda berhak mendapatkan informasi yang Anda inginkan. Bila ada yang kurang jelas, misalnya soal pilihan jenis obat (generik atau paten), dosis, tindakan medis, pasien juga memiliki hak bertanya atas kuitansi tagihan rumah sakit bagi penderita rawat inap untuk diklarifikasi hingga jelas benar, juga mengenai penggunaan obat dan peralatan yang harus bayar.

* Mencermati dan meneliti tindakan medis apa saja yang sudah lakukan, apakah sesuai dengan yang seharusnya dibayarkan. Adalah hak pasien untuk mengetahui setiap rupiah yang dikeluarkan untuk membayar biaya rumah sakit.

Red : Kes. Kompas

When Fights Over Money Ruin Marriages

Much has been written about how tough economic times have forced couples to postpone divorces. They just can't afford it. Legal costs and accountant fees grow as a union dissolves and a two-income household lives cheaper than a two-household pair of singles. As the economy improves, we will probably see divorce rates creep up. But even if money woes are keeping couples together, financial disputes remain the root cause of irreconcilable differences

Here are seven common financial issues that can lead to divorce:

Paycheck Envy
More women are entering marriage with assets of their own and many are earning more than their spouses. According to the Bureau of Labor Statistics, one in three married women out-earns her husband. That amount expands to more than half if they earn $55,000 or more. Men can feel threatened by not having their traditional bragging rights as breadwinners. For women, it means they have their own money to protect from the irresponsible actions of a mate. With more at-stake, women can't afford to be deferential to their mate the way past generations were.

Debt
Utah State University professor Jeffrey Dew authored a widely cited study that concluded that couples who argue about finances at least once a week are 30% more likely to divorce than those who only vent occasionally about money issues. Couples with no assets were 70% more likely to divorce compared to couples with assets of $10,000. Cutting into the ability to build assets is America's longstanding addiction to credit cards, but there may be cause for optimism. Having amassed a record-setting $988 billion in revolving debt in 2008, Americans chipped away at nearly $90 billion of it last year, according to the Federal Reserve. Fewer credit cards and less debt should mean increased savings, more assets and potentially happier couples.

Bills
As part of a survey last year, Fidelity Investments found that less than half of couples make day-to-day financial decisions together on issues such as budgeting and paying bills (45%). In many couples, one person always pays monthly bills early while the other might procrastinate until the due date and beyond. Cutting checks can be even more stressful when an unnecessary shopping spree blows the monthly budget or a mate doesn't take kindly to the premium cable channels or costly text messages their better half piles into the mix.

Saving
While one half of a relationship may be thrifty, dedicated to building savings and committed to a retirement plan, the other may be more carefree, with a "live for today, you can't take it with you" outlook.

Investing
One can assume that investment decisions are increasingly dividing couples if both partners are financially savvy. Risk tolerance may be incompatible, with goals out-of-synch.

Dump
Apple or go long may be as divisive a debate as how often a mother-in-law should visit. Looking over an investment portfolio or 401(k) plan, one spouse may want to explore emerging market funds, while the other dismisses anything but safe domestic large caps and bonds. Can a quant guy find true happiness with a fundamental-analysis kind of gal?

Differing Expectations
There's no shortage of men and women who value money more than love and companionship. You may be quite content to "live on love" and weather financial situations "for better or worse." But she may feel entitled to a McMansion in a tony suburb and a Mercedes in which to drive your kids to private school. Trouble will be brewing along with her high-priced lattes.

Secret Stash
Financial infidelity is a newly coined term that describes situations in which a spouse hides cash or credit from his mate. It may seem a good idea to have a secret credit card or bank account that you can dip into, but your partner will probably take great offense at the covert action. Beyond the financial dishonesty on display, such hidden reserves may be a warning sign of even bigger transgressions -- keeping a slush fund to pay for strip club tabs or supporting a mistress on the sly.

The Link Between Endometriosis and Cancer

Endometriosis and Cancer Risk

Women with endometriosis appear to be more likely to develop certain types of cancer. What scientists know about the link -- and why it might occur -- were the focus of a session at the inaugural symposium of the Endometriosis Foundation of America.

"We've got pretty good evidence that there's some increase in the risk for ovarian cancer" with endometriosis, said Louise Brinton, PhD, Chief of the Hormonal and Reproductive Epidemiology branch at the National Cancer Institute, in an interview with Medscape following the session. "But there are still other cancers that need further study."

Dr. Brinton's interest in the long-term effects of endometriosis led her to Sweden about 20 years ago. Using the country's national inpatient register, she identified more than 20,000 women who had been hospitalized for endometriosis. After an average follow-up of more than 11 years, the risk for cancer among these women was elevated by 90% for ovarian cancer, 40% for hematopoietic cancer (primarily non-Hodgkin's lymphoma), and 30% for breast cancer. Having a longer history of endometriosis and being diagnosed at a young age were both associated with increased ovarian cancer risk.

"We found an increased risk for tumors with increasing years of follow-up," said Dr. Brinton, "making it unlikely that the ovarian cancer diagnoses were related to increased surveillance during endometriosis treatment." Also of special interest was the finding that "women whose site of origin of endometriosis was the ovary ... had a particularly high risk for ovarian cancer."

Dr. Brinton and colleagues published their research in 1997. A larger, more recent examination of the Swedish register, published in 2006 by Anna-Sofia Melin and colleagues, produced similar results.

"The 2 studies indicate a high risk related to follow-up time and site of origin of endometriosis, which suggests a biologic effect between the 2 diseases," said Dr. Brinton. On the other hand, confounding factors could be at work. For example, women being treated for endometriosis are more likely to be experiencing infertility, which affects risk because childbearing offers some protection against ovarian cancer.

A 2002 pooled case-control study by Roberta B. Ness and colleagues found that the odds of developing ovarian cancer were 50% higher among women diagnosed with endometriosis, even after adjusting for factors such as duration of oral contraception use and number of births. The risk was even higher -- a 3.5-fold increase -- for women with endometrioid or clear cell tumors, 2 subtypes of ovarian cancer. A 2005 case-control study by Brinton and colleagues also found a 2.5- to 3.5-fold increase in endometrioid and clear cell tumors among women with endometriosis.

The overall lifetime risk for ovarian cancer is 1.4%, according to the American Cancer Society. Endometriosis affects as many as 7% to 15% of women of reproductive age.

Farr Nezhat, MD, Chief of Gynecologic Minimally Invasive Surgery and Robotics at St. Luke's and Roosevelt Hospitals in New York City and Professor of Obstetrics and Gynecology at Columbia University, spoke on the pathogenesis of endometriosis and ovarian cancer. Dr. Nezhat also cited research on the link between epithelial ovarian cancer and endometriosis. According to a 2000 study of women with ovarian cancer by Hiroyuki Yoshikawa and colleagues, endometriosis was present in 39% of the women with clear cell tumors and 21% of those with endometrioid tumors, vs just 3% of those with serous or mucinous tumors.

Dr. Nezhat's own research with Liane DeLigdisch and colleagues also identified a link between endometriosis and ovarian cancer. A pathology review of samples from 76 patients with stage 1 ovarian cancer revealed that most were associated with endometriosis or endometrioma. Most patients presented with pelvic pain or adnexal mass, supporting the idea that healthcare providers should be alert to the possibility of ovarian cancer in women with a history of endometriosis.

Studies have been inconsistent on whether endometriosis is linked to breast cancer or non-Hodgkin's lymphoma. Anecdotal evidence has linked endometriosis to melanoma, brain and endocrine cancers, and thyroid cancer. Large epidemiologic studies are required to examine these associations.

The Pathogenesis of Endometriosis and Cancer
What do endometriosis and ovarian cancer have in common? A lot, it turns out.

"Both of these diseases are progressive and depend on estrogen for their growth," said Dr. Nezhat. Studies have shown that endometrial tissue shows elevated activity of aromatase, an enzyme used for a key step in the biosynthesis of estrogens.

Another factor that appears to play a role in both diseases is inflammation. "We know that inflammation can cause cancer, as in hepatitis of the liver and asbestosis of the lung," said Dr. Nezhat. Endometriosis is characterized by a chronic inflammatory state, which leads to the release of cytokine. These cytokines may promote the growth of tumors by causing unregulated mitotic division, growth, and differentiation.

"If you combine inflammation with estrogen, it's going to be a vicious circle," said Dr. Nezhat.

The 2 diseases share numerous other characteristics. For example, both are related to early menarche and late menopause, infertility, and nulliparity. Factors that relieve or offer protection against both conditions include tubal ligation, oral contraceptives, hysterectomy, and progesterone exposure.

Mutations in genes that are known to suppress tumors, such as PTEN, p53, and bcl, have been found in both ovarian tumors and adjacent endometriotic lesions.

Of course, links between the 2 diseases don't prove that one causes the other. But Dr. Nezhat said there's reason to believe that endometriosis contributes to ovarian cancer, as evidenced by Dr. Brinton's finding that cancer risk increases with duration of endometriosis.

If endometriosis does increase the risk for ovarian cancer, then treating it might reduce the risk. "Endometrial implants produce estrogen and inflammation," he said. "So if you remove the endometriosis, you should theoretically reduce the risk for cancer."

Advice to Surgeons and Patients
Dr. Nezhat said that surgeons who operate on women with endometriosis, which includes fertility specialists performing in vitro fertilization (IVF), need to be alert to the possibility of ovarian cancer. "Do an ultrasound during the preoperative evaluation and during the follow-up," he told Medscape. He also cautioned surgeons to biopsy any ovarian cysts instead of draining them. "Every adnexal mass has to be thoroughly evaluated," he said.

Although the elevated risk for ovarian cancer appears to be real, Dr. Brinton emphasized that women with endometriosis should not become anxious about it. "Even though we see a 2- to 3-fold increase in the risk for ovarian cancer, it's still a very rare condition," she said. "The absolute risk is low."

The New FIGO Staging for Carcinoma of the Vulva, Cervix, Endometrium, and Sarcomas

The International Federation of Gynecology and Obstetrics (FIGO) staging systems for vulva, cervix, endometrium, and sarcomas have been revised for the first time in over a decade. The purpose of the staging system is to provide uniform terminology for better communication among health professionals and to provide appropriate prognosis to the patients which results in treatment improvement. This is a constantly evolving process as new therapeutic modalities are developed, new imaging and surgical approaches are applied, and more prognostic information becomes available. The previous system did not reflect the prognosis in some patient subsets where medical research and practice have shown explosive growth of new knowledge in recent years. The 41st Annual Meeting of the Society of Gynecologic Oncologists was held in March 2010. Several abstracts reported retrospective studies that evaluated the prognostic significance of new 2009 FIGO staging guidelines compared to the old 1988 FIGO system. In endometrial cancer, the reduction in the substages within stage I, and the separation of pelvic and para-aortic nodal involvement further clarified important prognostic factors that yielded clear delineation of survival. The new 2009 FIGO vulvar cancer staging system was validated by clearly demonstrating distinct groups with differing survivals. The following revisions on carcinoma of vulva, cervix, and endometrium staging will replace prior tables 41-6, 41-8, and 41-9, respectively.

Carcinoma of the Vulva

IA Tumor confined to the vulva or perineum, = 2cm in size with stromal invasion = 1mm, negative nodes

IB Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes

II Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes

IIIA Tumor of any size with positive inguino-femoral lymph nodes
(i) 1 lymph node metastasis greater than or equal to 5 mm
(ii) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB
(i) 2 or more lymph nodes metastases greater than or equal to 5 mm
(ii) 3 or more lymph nodes metastases less than 5 mm

IIIC Positive node(s) with extracapsular spread

IVA
(i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
(ii) Fixed or ulcerated inguino-femoral lymph nodes IVB Any distant metastasis including pelvic lymph nodes

Carcinoma of the Cervix

IA1 Confined to the cervix, diagnosed only by microscopy with invasion of <>
IA2 Confined to the cervix, diagnosed with microscopy with invasion of > 3 mm and <>
IB1 Clinically visible lesion or greater than A2, <>
IB2 Clinically visible lesion, > 4 cm in greatest dimension
IIA1 Involvement of the upper two-thirds of the vagina, without parametrial invasion, <>
IIA2 > 4 cm in greatest dimension
IIB With parametrial involvement
IIIA/B Unchanged
IVA/B Unchanged

Carcinoma of the Endometrium

IA Tumor confined to the uterus, no or < ½ myometrial invasion
IB Tumor confined to the uterus, > ½ myometrial invasion
II Cervical stromal invasion, but not beyond uterus
IIIA Tumor invades serosa or adnexa
IIIB Vaginal and/or parametrial involvement
IIIC1 Pelvic node involvement
IIIC2 Para-aortic involvement
IVA Tumor invasion bladder and/or bowel mucosa
IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

Uterine sarcomas were staged previously as endometrial cancers, which did not reflect clinical behavior. Therefore, a new corpus sarcoma staging system was developed based on the criteria used in other soft tissue sarcomas. This is described as a best guess staging system, so data will need to be collected and evaluated for further revision.

Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

IA Tumor limited to uterus <>
IB Tumor limited to uterus > 5 cm
IIA Tumor extends to the pelvis, adnexal involvement
IIB Tumor extends to extra-uterine pelvic tissue
IIIA Tumor invades abdominal tissues, one site
IIIB More than one site
IIIC Metastasis to pelvic and/or para-aortic lymph nodes
IVA Tumor invades bladder and/or rectum
IVB Distant metastasis

Adenosarcoma Stage I Differs from Other Uterine Sarcomas
IA Tumor limited to endometrium/endocervix
IB Invasion to < ½ myometrium IB Invasion to > ½ myometrium