## FIGO 2009 Cervical Cancer Staging The patient has squamous cell carcinoma of the cervix with **pelvic lymph node metastases (2/15 nodes positive)**. This is the critical finding that determines staging. ### Key Point: **FIGO 2009 introduced lymph node status as a staging criterion for the first time.** Pelvic lymph node involvement automatically upgrades the stage to **Stage IIIC1**, regardless of local tumour extent or parametrial involvement. ### Staging Logic: - **Stage IB1**: Tumour confined to cervix, ≤4 cm, **no lymph node involvement** → Does not apply here due to positive nodes - **Stage IIB**: Tumour extends beyond cervix to parametrium, **no lymph node involvement** → Does not apply; this patient has nodal disease - **Stage IIIC1**: **Pelvic lymph node metastases** (unilateral or bilateral) → **CORRECT** - **Stage IIIA**: Tumour extends to lower third of vagina, **no parametrial involvement, no nodal disease** → Does not fit; patient has nodal involvement ### High-Yield: **FIGO 2009 vs. FIGO 1995**: The 2009 revision fundamentally changed cervical cancer staging by incorporating lymph node status. Any pelvic LN involvement = Stage IIIC (now subdivided into IIIC1 for pelvic nodes, IIIC2 for para-aortic nodes in 2018 revision, but 2009 uses IIIC1 for pelvic). ### Clinical Pearl: The presence of 2 positive pelvic lymph nodes is the **dominant staging factor** here. Even though the tumour is small (2.5 cm, technically IB1 by size) and confined to stroma without parametrial spread, nodal involvement mandates upstaging to IIIC1.
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