Under the revised FIGO 2018 staging for cervical carcinoma, which change was most significant compared to FIGO 2009?

• A Introduction of Stage IVA for bladder involvement
• B Removal of tumour size as a staging criterion
• C Addition of lymph-vascular space invasion as a staging criterion
• D Incorporation of imaging and pathological lymph node status to upstage to Stage IIIC ✓

Explanation

The landmark change in FIGO 2018 was inclusion of lymph node metastasis as a staging criterion: Stage IIIC1 = pelvic lymph node metastasis only; IIIC2 = para-aortic lymph node metastasis. This was irrespective of tumour size or local extent. Lymph node status can be determined by imaging (r suffix) or pathology (p suffix). This aligned clinical staging with actual prognostic determinants since lymph node metastasis is the single most important prognostic factor.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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