Molecular staging of gynecological cancer: What is the future?

• There is no universally accepted molecular staging system for gynecologic cancers.
• Different genetic alterations give rise to heterogeneity of gynecologic cancers.
• Biomarkers are associated with response to therapy and clinical outcomes.
• Clinical trials are evaluating novel drug therapies that target molecular pathways.
• Molecular classification is feasible and desirable for comprehensive cancer staging.

The purpose of cancer staging is to classify cancers into prognostic groups and to allow for comparison of treatment results and survival between patients and institutions. Staging for gynecologic cancers is based on extent of disease and metastasis, which was historically determined by physical examination and is now based on surgical and histologic examination of tumor specimens. Although the extent of disease is currently considered the most important predictor of recurrence and survival, current staging does not include molecular features that are associated with tumor aggressiveness, response to therapy, and prognosis. This review focuses on genomic and proteomic features of gynecologic cancers and the future of biomarkers in staging classification.