2. INTRODUCTION
• Staging of carcinoma cervix is the oldest staging system in
oncology practice
• First FIGO consensus staging came in 1950
• Initial staging system largely considered it as a local pelvic
disease
• Initially it was surgically staged
• Recent staging systems were vastly clinical with ancillary
diagnostic tools
• Previous modification was done in 2009.
3. 2009 FIGO STAGING PIT
FALLS
BASED ON CLINICAL EXAMINATION
• NO NODAL INVOLVEMENT CONSIDERED
• 1B1 IS A VERY BROAD CATEGORY
• NO IMAGING INCLUDED
• NO PATHOLOGY INCLUDED
4. FIGO STAGING 2018 – SALIENT FEATURES
• The horizontal dimension is no longer considered in defining the upper
boundary of a Stage IA carcinoma.
• The diagnosis of Stage IA1 and IA2 carcinomas is made on microscopic
examination of a surgical specimen, which includes the entire lesion. The
margins of an excision specimen should be reported to be negative for
disease.
• Although it is stated in the FIGO document that if the margins of the cone
biopsy are positive for invasive cancer with a tumour with dimensions of IA
carcinoma, the patient is assigned to IB1 in practice. In the event that the
margins of a cone/ loop biopsy are positive for disease, a repeat cone/ loop
biopsy is required to stage the patient.
5. FIGO STAGING 2018 – SALIENT FEATURES
• Stage IB has been sub-divided into IB1, IB2 and IB3 based on
maximum tumour size.
• The revised 2018 system includes nodal status; the presence of
nodal involvement in a tumour of any size upstages the case to
Stage IIIC, with IIIC1 indicating pelvic and IIIC2 indicating para-
aortic nodal involvement.
6. IMAGING
• Imaging evaluation may now be used in addition to clinical
examination where resources permit
• The revised staging permits the use of any of the imaging modality
according to available resources i.e USG,CT,MRI,PET to provide
information about tumor size,nodal status and local/systemic spread
• The goal is to identify the most appropriate method and to avoid
dual therapy with surgery and radiation as this has the potential to
greatly augment morbidity
7. PATHOLOGY
• Pathology report is an important source for accurate
assessment of the extent of disease
• The stage is to be allocated after all imaging and pathology
reports are available
• Pathological findings supersede imaging and clinical findings.
• LVSI does not change the stage of the disease.
8. STAGE 1-LIMITED
TO CERVIX
It is divided into stages IA and IB, based on
the size of the tumor and the depth of
tumor invasion.
Stage IA is subdivided based on the depth
of tumor invasion.
In stage IA1, the cancer is not
more than 3 millimeters deep.
In stage IA2, the cancer is
more than 3 but not more than 5
millimeters
9. STAGE 1 B-
INVASIVE CA WITH
MEASURED DEEPEST
INVASION >5 MM
Stage IB1: The tumor is
2 centimeters or smaller and the
tumor invasion is more than 5
10. STAGE 1B2 AND
1B3
In stage IB2, the cancer is
larger than 2 centimeters but
not larger than 4 centimeters.
In stage IB3, the cancer is
larger than 4 centimeters (>4
cm )
13. STAGE II – INVADES BEYOND
THE UTERUS BUT NOT
EXTENDED ONTO THE LOWER
1/3RD OF VAGINA OR TO THE
PELVIC WALL
Stage IIA – involvement limited to
upper 2/3rd of the vagina without
parametrial invasion
In stage IIA1, the cancer is 4
centimeters or smaller.
In stage IIA2, the cancer is larger
than 4 centimeters.
14. In STAGE IIB, cancer has
spread from the cervix to the
tissue around the uterus i.e
with parametrial invasion but
not upto the pelvic wall
15. STAGE III
• Has Stage IIIC compared to early staging
• Stage IIIA AND IIIB remain unchanged
• Stage IIIC includes imaging or pathologic information as well to
diagnose pelvic and/or para aortic lymph node involvement
including micro-metastasis irrespective of tumor size and
extent
17. STAGE III – INVOLVES THE
LOWER THIRD OF VAGINA
AND/OR EXTENDS TO THE
PELVIC WALL AND/OR CAUSES
HYDRONEPHROSIS OR NON
FUNCTIONING KIDNEY AND/OR
INVOLVES PELVIC AND/OR
PARA AORTIC LYMPH NODES
STAGE IIIA-Involves lower
third of vagina ,with no
extension to the pelvic wall
18. STAGE IIIB- Extension to the
pelvic wall and /or
hydronephrosis or non
functioning kidney
19. STAGE III C-INVOLVEMENT OF
PELVIC AND/OR PARAAORTIC
LYMPH NODE
(INCLUDING
MICROMETASTASIS),IRRESPECTI
VE OF TUMOR SIZE AND EXTENT
Stage IIIC1-Pelvic lymph
node metastasis only
Stage IIIC2-Para aortic
lymph node metastasis
20. STAGE IV- EXTENDED BEYOND
THE TRUE PELVIS OR HAS
INVOLVED THE MUCOSA OF
BLADDER OR RECTUM
Stage IVA-Spread of the growth
to adjacent organs
Stage IV B- Spread to distant
organs
23. TUMOR SIZE ASSESSMENT CAN BE DONE BY
• Imaging studies-USG scan
CT scan
MRI,PET
Physical examination-Clinical examination
Under anaesthesia
interobsever variability
Pathological evaluation-Depth of invasion
horizontal spread
multifocal disease
Third dimension
24. APPENDIX
• Microscopic disease (1A) now considers only deep stromal
invasion disregarding horizontal spread
• Early clinically visible tumor (1B) now incorporates microscopic
finding and imaging as well as depending upon availability
• 1 B is further divided into I B1,1B2,1B3 ,depending upon size of
tumor
• Addition of 1B3 is new to this staging system.
