A 42-year-old woman from rural Maharashtra presents with postcoital bleeding and vaginal discharge for 3 months. On examination, a friable cervical mass is noted. Pap smear shows high-grade squamous intraepithelial lesion (HSIL). Colposcopy-directed biopsy confirms squamous cell carcinoma. MRI pelvis shows a 4 cm cervical lesion with parametrial invasion but no distant metastases. Pelvic lymph nodes are not enlarged on imaging. What is the FIGO 2009 stage of this cervical cancer?

Explanation

## FIGO 2009 Cervical Cancer Staging **Key Point:** FIGO 2009 staging is based on clinical examination and imaging findings. The presence of parametrial invasion defines stage IIB, regardless of tumor size. ### Staging Criteria in This Case | Feature | Finding | Stage Implication | |---------|---------|-------------------| | Tumor size | 4 cm | ≥4 cm = IB2 (if confined to cervix) | | Parametrial invasion | Present | Moves to stage II | | Pelvic sidewall involvement | Absent | Not stage III | | Distant metastases | Absent | Not stage IV | ### FIGO 2009 Stage IIB Definition 1. Tumor invades beyond the cervix 2. Involves parametrium 3. Does NOT extend to pelvic sidewall or lower third of vagina 4. No distant metastases **High-Yield:** Parametrial invasion is the hallmark of stage II disease. Stage IIB specifically means parametrial involvement without pelvic sidewall extension. **Clinical Pearl:** MRI is the imaging modality of choice to assess parametrial invasion, as it provides superior soft-tissue contrast compared to CT. The presence of parametrial edema or frank invasion on T2-weighted images confirms stage IIB. ### Why Not Other Stages? - **Stage IB1** (≤4 cm confined to cervix) or **IB2** (>4 cm confined to cervix): Ruled out because parametrial invasion is present. - **Stage IIIA** (extends to lower third of vagina): No vaginal involvement documented. **Mnemonic:** PARAMETRIAL = Stage II. PELVIC SIDEWALL = Stage III. BLADDER/RECTUM = Stage IV. [cite:FIGO 2009 Staging Guidelines, Gynecologic Oncology 2009]