April 2025—Seen through the lens of metaphor, cancer staging is traffic control. Identify the biological crash, so to speak, and its severity; direct and redirect therapy; and try, ultimately, to unsnarl persistently risky crossings. That’s the sunny ideal. But efforts to improve traffic flow can also give rise to strong reactions, usually in words (if not a chorus of honking horns). Such is the case with the updated International Federation of Gynecology and Obstetrics staging system for endometrial cancer. FIGO 2023, by nearly all accounts, differs sharply from what had come before, incorporating molecular alterations, lymphovascular invasion, and tumor type and grade. Nearly two years later, it has yet to merge seamlessly into practice. “It definitely is controversial,” says Ekene Okoye, MD, associate professor of clinical pathology and genomic medicine, Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College.