In the FIGO 2018 revision, which was the MAJOR change from the 2009 staging for cervical cancer that significantly impacts treatment planning?
- A Lymph node metastasis (Stage IIIC) now included based on imaging or pathology ✓
- B Tumour size cutoff changed from 4 cm to 2 cm for Stage IB
- C Vaginal involvement now classified as Stage IV
- D Clinical examination replaced by MRI as the sole staging modality
Correct answer: A. Lymph node metastasis (Stage IIIC) now included based on imaging or pathology
Explanation
The landmark change in FIGO 2018 was the addition of Stage IIIC, which classifies pelvic (IIIC1) and para-aortic (IIIC2) lymph node involvement based on imaging (suffix 'r') or pathological confirmation (suffix 'p'). This dramatically upgrades many patients who previously would have been Stage IB or IIA, and directly influences the addition of extended-field radiotherapy. Tumour size revision (IB1/IB2/IB3) was also made, but lymph node staging was the most impactful change.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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