A 48-year-old woman from rural Maharashtra presents with postmenopausal bleeding and vaginal discharge for 3 months. On speculum examination, a friable, bleeding cervical mass is noted. Pap smear shows atypical squamous cells of undetermined significance (ASCUS). Colposcopy-directed cervical biopsy confirms squamous cell carcinoma. MRI pelvis shows a 3 cm cervical lesion with no parametrial involvement, intact uterosacral ligaments, and no pelvic lymph node enlargement. What is the FIGO 2009 stage of this cervical cancer?

Explanation

## FIGO 2009 Cervical Cancer Staging **Key Point:** FIGO 2009 staging is clinical/imaging-based and does NOT include lymph node status in the stage assignment (unlike TNM). Lymph node involvement is reported separately as a prognostic factor. ### Stage Determination in This Case The patient has: - Tumor size: **3 cm** - **No parametrial involvement** (intact uterosacral ligaments, no parametrial invasion on MRI) - **Confined to cervix and upper 2/3 vagina** - No distant metastases This corresponds to **Stage IB1** (tumor >2 cm but ≤4 cm, confined to cervix). ### FIGO 2009 Staging Table | Stage | Criteria | |-------|----------| | **IA** | Invasive cancer diagnosed only by microscopy; IA1 (≤3 mm depth, ≤7 mm width), IA2 (>3–5 mm depth, ≤7 mm width) | | **IB** | Clinically visible lesion confined to cervix; IB1 (≤4 cm), IB2 (>4 cm) | | **II** | Tumor extends beyond cervix but not to pelvic sidewall/lower 1/3 vagina; IIA (no parametrial invasion), IIB (with parametrial invasion) | | **III** | Extends to pelvic sidewall and/or lower 1/3 vagina and/or causes hydronephrosis; IIIA (no pelvic sidewall extension), IIIB (pelvic sidewall extension and/or hydronephrosis), IIIC (pelvic/para-aortic nodes) | | **IV** | Extends beyond true pelvis or involves bladder/rectal mucosa; IVA (local extension), IVB (distant metastases) | **High-Yield:** A 3 cm cervical mass with no parametrial involvement = **IB1**. The 4 cm cutoff is critical: ≤4 cm = IB1; >4 cm = IB2. **Clinical Pearl:** MRI is the gold standard for assessing parametrial invasion, which is the key discriminator between Stage IB (no parametrial involvement) and Stage IIA/IIB (parametrial involvement). ### Why Not Other Stages? - **IA2:** Reserved for microscopic lesions with 3–5 mm invasion depth; this is a clinically visible mass. - **IIA1:** Requires tumor extension beyond cervix into upper 2/3 vagina or parametrial invasion; this tumor is confined to cervix. - **IIB:** Requires parametrial invasion, which is explicitly absent here. [cite:FIGO 2009 Cervical Cancer Staging Guidelines]