FIGO Staging Classification for Cervical Cancer

The 2018 International Federation of Gynecology and Obstetrics (FIGO) uterine cervical cancer staging system introduces a new primary tumor size cutoff value of 2 cm (ie, stage IB1 vs IB2), used to evaluate patients for fertility-sparing radical trachelectomy and to estimate prognosis.

FIGO staging of carcinoma of the cervix uteri

Stage I: The carcinoma is strictly confined to the cervix uteri (extension to the corpus should be disregarded)
• IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mm^a

⚬ 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^b

⚬ 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: The 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-thirds of the vagina without parametrial involvement

⚬ IIA1 Invasive carcinoma <4 cm in greatest dimension
⚬ IIA2 Invasive carcinoma ≥4 cm in greatest dimension

• IIB With parametrial involvement but not up to the pelvic wall

Stage III: The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or paraaortic lymph nodes^c
• IIIA Carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
• IIIB Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney (unless known to be due to another cause)
• IIIC Involvement of pelvic and/or paraaortic lymph nodes, irrespective of tumor size and extent (with r and p notations)^c

⚬ IIIC1 Pelvic lymph node metastasis only
⚬ IIIC2 Paraaortic 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

^a Imaging and pathology can be used, when available, to supplement clinical findings with respect to tumor size and extent, in all stages.
^b The involvement of vascular/lymphatic spaces does not change the staging. The lateral extent of the lesion is no longer considered.
^c 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 and, 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.

 

References:

1. Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-135. [Medline]
2. Balaya V, Guani B, Magaud L, Bonsang-Kitzis H, Ngô C, Mathevet P, Lécuru F, On Behalf Of The Senticol Group. Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage. Cancers (Basel). 2020 Nov 28;12(12):3554. [Medline]

 

Created Jan 25, 2021.