TABLE 1.
Cervical cancer staging FIGO 2009 compared with FIGO 2018
| FIGO 2009 | FIGO 2018 |
|---|---|
| Stage I: The carcinoma is strictly confined to the cervix uteri (extension to the corpus is disregarded) IA Invasive carcinoma that can be diagnosed only by microscopy with deepest invasion ≤5 mm and largest extension ≤7 mm IA1 Measured stromal invasion ≤3 mm in depth and extension ≤7 mm IA2 Measured stromal invasion >3 mm and not >5 mm with extension not >7 mm IB Clinically visible lesions limited to cervix or preclinical cancers greater than stage IA* IB1 Clinically visible lesion ≤4 cm in greatest dimension IB2 Clinically visible lesion >4 cm in greatest dimension | Stage I: The carcinoma is strictly confined to the cervix uteri (extension to the corpus is disregarded) IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion ≤5 mm† IA1 Measured stromal invasion ≤3 mm in depth IA2 Measured stromal invasion >3 mm and ≤5 mm in depth IB Invasive carcinoma with measured deepest invasion >5 mm (greater than stage IA); lesion limited to the cervix uteri with size measured by maximum tumor diameter‡ IB1 Invasive carcinoma >5 mm depth of stromal invasion and ≤2 cm in greatest dimension IB2 Invasive carcinoma >2 cm and ≤4 cm in greatest dimension IB3 Invasive carcinoma >4 cm in greatest dimension |
| Stage II: Cervical carcinoma invades beyond uterus, but not to pelvic wall or lower third vagina IIA Without parametrial invasion IIA1 Clinically visible lesion ≤4 cm in greatest dimension IIA2 Clinically visible lesion >4 cm in greatest dimension IIB With obvious parametrial invasion | Stage II: The cervical carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall IIA Involvement limited to the upper two-third of the vagina without parametrial invasion IIA1 Invasive carcinoma ≤4 cm in greatest dimension IIA2 Invasive carcinoma >4 cm in greatest dimension IIB With parametrial invasion but not up to pelvic wall |
| Stage III: The tumor extends to the pelvic wall and/or involves lower third of vagina and/or caused hydronephrosis or nonfunctioning kidney IIIA Tumor involves lower third of vagina with no extension to pelvic wall IIIB Extension to pelvic wall and/or hydronephrosis or nonfunctioning kidney | Stage III: The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes IIIA Carcinoma involves lower third of the vagina, with no extension to the pelvic wall IIIB Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause) IIIC Involvement of pelvic and/or para-aortic lymph nodes (including micrometastases)§, irrespective of tumor size and extent (with r and p notations)∥ IIIC1 Pelvic lymph node metastasis only IIIC2 Para-aortic lymph node metastasis |
| Stage IV: The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to Stage IV IVA Spread of the growth to adjacent organs IVB Spread to distant organs | Stage IV: The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV IVA Spread of the growth to adjacent organs IVB spread to distant organs |
All macroscopically visible lesions—even with superficial invasion—are allotted to stage IB carcinomas.
Imaging and pathology can be used, when available, to supplement clinical findings with respect to tumor size and extent, in all stages. Pathological findings supersede imaging and clinical findings.
The involvement of vascular/lymphatic spaces should not change the staging. The lateral extent of the lesion is no longer considered.
Isolated tumor cells do not change the stage but their presence should be recorded.
Adding notation of r (imaging) and p (pathology) to indicate the findings that are used to allocate the case to stage IIIC. For example, if imaging indicates pelvic lymph node metastasis, the stage allocation would be Stage IIIC1r; if confirmed by pathological findings, it would be stage IIIC1p. The type of imaging modality or pathology technique used should always be documented. When in doubt, the lower staging should be assigned.