A 46-year-old woman has a 5 cm exophytic squamous cell carcinoma of the cervix extending to the upper two-thirds of the vagina. Parametria are free on examination and MRI, and imaging shows no lymphadenopathy. What is the correct FIGO 2018 stage and best primary treatment?

• A Stage IIA2, concurrent chemoradiation with brachytherapy ✓
• B Stage IIA2, radical hysterectomy with lymphadenectomy
• C Stage IIIA, neoadjuvant chemotherapy followed by surgery
• D Stage IIA1, simple hysterectomy with adjuvant radiotherapy

Explanation

Upper two-thirds vaginal involvement without parametrial spread is Stage IIA; tumour size greater than 4 cm makes it IIA2. Tumours larger than 4 cm have excessive surgical morbidity and higher recurrence rates with radical hysterectomy alone, so definitive concurrent cisplatin-based chemoradiation with brachytherapy is the standard of care. Lower-third vaginal involvement would be IIIA, and IIA1 applies only when the tumour is 4 cm or smaller.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.