A 42-year-old woman from rural Maharashtra presents with postcoital bleeding and vaginal discharge for 3 months. She is a tobacco chewer and has been married since age 18. On examination, a 3 cm ulceroinfiltrative lesion is seen on the cervix. Pap smear shows high-grade squamous intraepithelial lesion (HSIL). Colposcopy-directed biopsy confirms invasive squamous cell carcinoma. MRI pelvis shows the tumor confined to the cervix with no parametrial involvement, and no lymph node enlargement. Cystoscopy and sigmoidoscopy are normal. What is the FIGO 2018 stage of this cervical cancer?

Explanation

## FIGO 2018 Cervical Cancer Staging — Key Concepts **Key Point:** FIGO 2018 staging for cervical cancer is based on tumor size and anatomical extent, NOT lymph node status (which is now recorded separately as N0/N1). ### Staging Criteria (FIGO 2018) | Stage | Criteria | |-------|----------| | **Stage I** | Tumor confined to cervix | | **IA** | Invasive tumor diagnosed only by microscopy; stromal invasion ≤5 mm depth, ≤7 mm width | | **IA1** | Stromal invasion ≤3 mm depth | | **IA2** | Stromal invasion >3 mm but ≤5 mm depth | | **IB** | Clinically visible tumor confined to cervix OR microscopic tumor >5 mm depth/width | | **IB1** | Tumor ≤4 cm in greatest dimension | | **IB2** | Tumor >4 cm in greatest dimension | | **Stage II** | Tumor extends beyond cervix but not to pelvic sidewall/lower third of vagina | | **IIA** | No parametrial involvement | | **IIB** | With parametrial involvement | ### Analysis of This Case 1. **Tumor location:** Confined to cervix (MRI confirms no parametrial involvement, cystoscopy/sigmoidoscopy normal) 2. **Tumor size:** 3 cm (clinically visible, >5 mm) 3. **Depth of invasion:** Clinically visible invasive lesion 4. **Lymph node status:** Not enlarged on imaging (recorded as N0, but does NOT affect FIGO stage) **Clinical Pearl:** A clinically visible tumor confined to the cervix, regardless of size up to 4 cm, is **Stage IB1** under FIGO 2018. Lymph node involvement is now a separate prognostic factor (N0/N1) recorded alongside the stage, not incorporated into the stage itself. **High-Yield:** The shift from FIGO 2009 to 2018 removed lymph node status from staging. This patient's N0 status is important for prognosis and treatment planning but does NOT change her stage from IB1. ### Why This Is IB1, Not Other Stages - **Not IA2:** IA2 is for microscopic tumors only; this is clinically visible. - **Not IIA:** IIA requires extension beyond cervix but NO parametrial involvement; this tumor is confined to cervix. - **Not IIB:** IIB requires parametrial involvement; MRI shows none.