A 42-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. Colposcopy-directed cervical biopsy confirms squamous cell carcinoma. MRI pelvis shows a 3 cm cervical lesion with no parametrial involvement, no pelvic lymph node enlargement, and no distant metastases. What is the FIGO 2009 stage of this cervical cancer?

Explanation

## FIGO 2009 Cervical Cancer Staging **Key Point:** FIGO 2009 staging for cervical cancer is based on clinical examination and imaging findings, NOT surgical findings (unlike FIGO 2018 which incorporates imaging and pathology). ### Staging Criteria | Stage | Criteria | |-------|----------| | **Stage I** | Carcinoma confined to cervix | | **IB1** | Clinically visible lesion ≤4 cm, no parametrial involvement | | **IB2** | Clinically visible lesion >4 cm, no parametrial involvement | | **IIA** | Invasion beyond cervix but not to pelvic sidewall/lower third vagina; no parametrial involvement | | **IIB** | Parametrial involvement but not to pelvic sidewall | | **IIIA** | Invasion to lower third of vagina, no pelvic sidewall involvement | | **IIIB** | Pelvic sidewall involvement or hydronephrosis/non-functioning kidney | ### Analysis of This Case 1. **Lesion size:** 3 cm (clinically visible, ≤4 cm) 2. **Location:** Confined to cervix 3. **Parametrial involvement:** Absent on MRI 4. **Pelvic lymph nodes:** No enlargement 5. **Vaginal/pelvic sidewall involvement:** None **Conclusion:** This patient meets criteria for **Stage IB1** — a clinically visible cervical lesion ≤4 cm with no parametrial involvement. **High-Yield:** The distinction between IB1 and IB2 is purely based on lesion size (≤4 cm vs >4 cm). Parametrial involvement automatically upgrades to Stage II. **Clinical Pearl:** MRI is the imaging modality of choice for cervical cancer staging because it best assesses parametrial invasion and pelvic sidewall involvement. However, in FIGO 2009, imaging findings are used to guide clinical staging, not to replace clinical examination.