In the FIGO 2018 cervical cancer staging revision, which of the following represents the most significant change from FIGO 2009?
- A Incorporation of radiological and pathological findings (including lymph node involvement) into staging ✓
- B Addition of vaginal extension as a criterion for Stage III disease
- C Reclassification of endocervical adenocarcinoma as a separate staging system
- D Removal of clinical examination findings from staging criteria
Explanation
The most significant change in FIGO 2018 cervical cancer staging is the incorporation of imaging and pathological findings, particularly lymph node status, into the staging system. Stage IIIC was newly introduced: IIIC1 = pelvic lymph node metastasis and IIIC2 = para-aortic lymph node metastasis — these are now staged as Stage IIIC regardless of primary tumour size, representing a major departure from purely clinical staging. The notation 'r' (imaging) or 'p' (pathology) is added to indicate the method of staging. This change aligns cervical cancer staging with other gynaecological cancers.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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