On cystoscopy of a patient with locally advanced cervical carcinoma, diffuse bullous oedema of the bladder base is noted. Biopsy of the oedematous area shows only submucosal oedema with intact mucosa. According to FIGO 2018 staging, this finding:
- A Does not upstage the tumour; only biopsy-proven mucosal involvement qualifies as IVA ✓
- B Stages the tumour as IVB because bullous oedema indicates haematogenous spread
- C Stages the tumour as IVA
- D Stages the tumour as IIIC2 because it implies nodal disease
Correct answer: A. Does not upstage the tumour; only biopsy-proven mucosal involvement qualifies as IVA
Explanation
FIGO Stage IVA requires invasion of the bladder or rectal mucosa, confirmed histologically where feasible. Bullous oedema alone is explicitly excluded from satisfying IVA criteria because it can result from tumour pressure, inflammation or venous congestion rather than true mucosal invasion. With submucosal oedema and intact mucosa on biopsy, the case remains staged according to the primary extent. Nodal status is recorded separately under IIIC and does not derive from bladder findings.
Reference: Williams Gynecology, 4th ed.
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