A 45-year-old woman has cervical carcinoma Stage IB2 (tumor 4.5 cm, confined to cervix). FIGO 2018 would now classify this as which stage, and what is the preferred treatment?

• A Stage IB2; radical hysterectomy alone
• B Stage IIA1; radical hysterectomy with adjuvant radiotherapy
• C Stage IIB; chemotherapy alone
• D Stage IB3; concurrent chemoradiation ✓

Explanation

In FIGO 2018 staging, Stage IB is sub-divided: IB1 (<2 cm), IB2 (2–4 cm), and IB3 (≥4 cm, confined to cervix). A 4.5 cm tumor confined to the cervix is Stage IB3. The preferred treatment for IB3 is concurrent cisplatin-based chemoradiation (external beam radiotherapy + brachytherapy with concurrent cisplatin) rather than surgery, as surgery for tumors ≥4 cm has high rates of adverse pathological features requiring adjuvant radiation anyway.

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

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