In the FIGO 2018 revised staging of cervical carcinoma, which change was most clinically significant?
- A Pelvic and para-aortic lymph node involvement, confirmed by imaging or pathology, now upstages disease to IIIC ✓
- B Stage IVA was redefined to include bladder and rectal involvement confirmed by biopsy only, not imaging
- C Parametrial involvement on MRI alone (without examination) was added to stage IIB criteria
- D Stage IA1 was expanded to include tumors up to 5 mm deep regardless of width
Correct answer: A. Pelvic and para-aortic lymph node involvement, confirmed by imaging or pathology, now upstages disease to IIIC
Explanation
The most significant change in FIGO 2018 cervical cancer staging is the addition of Stage IIIC, which allows upstaging based on lymph node involvement detected by imaging (IIIC1 = pelvic nodes; IIIC2 = para-aortic nodes) or pathology — previously, lymph node status was not part of clinical FIGO staging. This aligns with evidence showing lymph node involvement is the single most important prognostic factor. The suffix 'r' (imaging) or 'p' (pathology) is added.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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