According to the 2018 FIGO staging of cervical cancer, a 42-year-old woman has a 5 cm cervical mass with parametrial invasion confirmed on MRI but no pelvic sidewall involvement, no hydronephrosis, and negative lymph nodes on CT. What is the FIGO 2018 stage?

• A FIGO Stage IIIA
• B FIGO Stage IIIC1r
• C FIGO Stage IIIB
• D FIGO Stage IIB ✓

Explanation

FIGO 2018 Stage IIB is parametrial invasion without pelvic sidewall extension. In the 2018 revision, the major change was incorporation of lymph node status: Stage IIIC1 indicates regional (pelvic) lymph node involvement, and Stage IIIC2 indicates para-aortic node involvement, with a suffix 'r' for radiologic and 'p' for pathologic diagnosis. Since lymph nodes are negative here, Stage IIIC1r does not apply. Parametrial invasion alone with no sidewall or nodal involvement = Stage IIB. This distinction is clinically important because IIB is managed with concurrent chemoradiation (cisplatin-based) whereas IA/IB may be surgical.

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

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