A 42-year-old woman from rural Maharashtra presents with postcoital bleeding and vaginal discharge for 3 months. She is a multipara (G5P5) and reports irregular menstrual cycles. On speculum examination, a friable, bleeding cervical mass is noted. Pap smear shows atypical squamous cells of undetermined significance (ASCUS). Cervical biopsy confirms squamous cell carcinoma. MRI pelvis shows a 3 cm lesion confined to the cervix with no parametrial involvement and normal pelvic lymph nodes. What is the FIGO 2009 stage of this cervical cancer?

Explanation

## FIGO 2009 Cervical Cancer Staging **Key Point:** The 2009 FIGO staging system for cervical cancer is based on clinical examination and imaging findings, NOT surgical staging (unlike ovarian cancer). ### Stage IB1 Criteria This patient meets Stage IB1 criteria: - Tumor **confined to the cervix** (no parametrial or vaginal involvement) - Tumor size **≥4 mm depth and ≤5 mm lateral spread** OR **>5 mm lateral spread but <2 cm in greatest dimension** - In this case, the 3 cm lesion with no parametrial involvement fits IB1 (lesion >2 cm but confined to cervix) ### FIGO 2009 Staging Summary | Stage | Criteria | |-------|----------| | **IA** | Invasive cancer diagnosed only by microscopy; IA1: ≤3 mm depth, ≤7 mm width; IA2: >3 mm but ≤5 mm depth, ≤7 mm width | | **IB** | Clinically visible lesion confined to cervix; IB1: <2 cm; IB2: 2–4 cm; IB3: >4 cm | | **II** | Tumor extends beyond cervix but not to pelvic sidewall/lower third vagina; IIA: no parametrial involvement; IIB: with parametrial involvement | | **III** | Extends to pelvic sidewall, lower third vagina, or causes hydronephrosis; IIIA: lower third vagina, no pelvic sidewall; IIIB: pelvic sidewall or hydronephrosis; IIIC: pelvic/para-aortic nodes | | **IV** | Extends beyond true pelvis or involves bladder/rectal mucosa; IVA: adjacent organs; IVB: distant metastases | **Clinical Pearl:** A 3 cm cervical lesion visible on speculum exam with no parametrial involvement is **Stage IB1** (clinically visible, confined to cervix, <4 cm). The absence of parametrial involvement rules out Stage IIB. **High-Yield:** The 2009 revision introduced **Stage IB3** (>4 cm) to better stratify prognosis. Stage IB cancers are treated with **radical hysterectomy with pelvic lymphadenectomy** (Wertheim's procedure) or **concurrent chemoradiation** depending on patient factors. ### Why Not Other Stages? - **IA2:** Requires microscopic diagnosis only; this patient has a **clinically visible** lesion. - **IIA1:** Requires **extension beyond cervix** (parametrial or vaginal involvement); this lesion is **confined to cervix**. - **IIB:** Requires **parametrial involvement**; MRI shows **normal parametrium**.