FIGO Staging of Carcinoma Cervix (2023 Revised FIGO Staging System)

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 The FIGO (International Federation of Gynecology and Obstetrics) staging system is used worldwide for staging carcinoma of the cervix. It is a clinical staging system that may be supported by imaging and pathological findings. It helps in determining prognosis, treatment planning, and comparison of treatment outcomes pre surgical disease..

Stage I: Carcinoma strictly confined to the cervix (extension to uterus is not considered)

  • Stage IA: Invasive carcinoma diagnosed only by microscopy. Stromal invasion ≤5 mm in depth.
    • IA1: Stromal invasion ≤3 mm in depth.
    • IA2: Stromal invasion >3 mm and ≤5 mm in depth.
  • Stage IB: Invasive carcinoma with stromal invasion >5 mm but limited to the cervix.
    • IB1: Tumor ≤2 cm in greatest dimension.
    • IB2: Tumor >2 cm and ≤4 cm.
    • IB3: Tumor >4 cm.

Stage II: Carcinoma extends beyond the cervix but not to the pelvic wall or lower third of the vagina

  • Stage IIA: Without parametrial invasion.
    • IIA1: Tumor ≤4 cm.
    • IIA2: Tumor >4 cm.
  • Stage IIB: With obvious parametrial invasion but not up to the pelvic wall.

Stage III: Tumor involves the lower third of the vagina, pelvic wall, causes hydronephrosis or non-functioning kidney, or involves pelvic/para-aortic lymph nodes

  • Stage IIIA: Involvement of the lower third of the vagina, but no extension to the pelvic wall.
  • Stage IIIB: Extension to the pelvic wall and/or causing hydronephrosis or non-functioning kidney.
  • Stage IIIC: Involvement of pelvic and/or para-aortic lymph nodes (regardless of tumor size or local extent)
    • IIIC1: Pelvic lymph node involvement.
    • IIIC2: Para-aortic lymph node involvement.

Note: Stage IIIC is a new addition introduced in the 2018 FIGO update, recognizing the importance of lymph node status in prognosis.

Stage IV: Carcinoma extends beyond the true pelvis or involves the mucosa of bladder or rectum

  • Stage IVA: Spread to adjacent pelvic organs (e.g., bladder or rectal mucosa), confirmed via biopsy.
  • Stage IVB: Distant metastasis (e.g., lungs, liver, bone).
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Important Notes:

  • Imaging (MRI, CT, PET-CT) and pathological findings are allowed to supplement clinical staging.
  • Clinical examination remains the cornerstone of staging, especially in resource-limited settings.
  • FIGO encourages precise tumor measurement and lymph node evaluation, enhancing accuracy in staging and treatment planning.

Conclusion: The FIGO staging system provides a structured and clinically useful way to classify cervical cancer. It emphasizes tumor size, local spread, lymph node involvement, and distant metastasis to guide appropriate treatment and predict outcomes.

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