Staging

Question 1

General Staging FIGO 2010

Answer 1

Stage IA: microscopic Dz, with ≤ 5 mm DOI and ≤ 7 mm horizontal spread. It is further delineated into IA1 (tumors ≤ 3 mm depth and ≤ 7 mm wide) and IA2 (tumors > 3 mm but ≤ 5 mm deep and ≤ 7 mm wide) Stage IB: clinically visible tumor or > IA2, with IB1 ≤ 4 cm, and IB2 being bulky tumors > 4 cm Stage IIA: invades beyond uterus/ cervix; involves the upper two-thirds of the vagina without parametrial invasion with IIA1 lesions ≤ 4 cm and IIA2 lesions > 4 cm Stage IIB: invades beyond uterus/ cervix and into parametria but not into pelvic wall or lower 3rd of vagina Stage IIIA: invades lower 3rd of vagina but no extension into pelvic wall Stage IIIB: invades pelvic sidewall and/ or causes hydronephrosis or nonfunctioning kidney Stage IVA: invades beyond true pelvis or mucosa of bladder or rectum (must be Bx proven); bullous edema of bladder or rectum does not count Stage IVB: DMs

Question 2

Stage 1A

Answer 2

Stage IA: microscopic Dz, with ≤ 5 mm DOI and ≤ 7 mm horizontal spread. It is further delineated into IA1 (tumors ≤ 3 mm depth and ≤ 7 mm wide) and IA2 (tumors > 3 mm but ≤ 5 mm deep and ≤ 7 mm wide)

Question 3

Stage IB

Answer 3

Stage IB: clinically visible tumor or > IA2, with IB1 ≤ 4 cm, and IB2 being bulky tumors > 4 cm

Question 4

Stage IIA

Answer 4

Stage IIA: invades beyond uterus/ cervix; involves the upper two-thirds of the vagina without parametrial invasion with IIA1 lesions ≤ 4 cm and IIA2 lesions > 4 cm

Question 5

Stage IIB

Answer 5

Stage IIB: invades beyond uterus/ cervix and into parametria but not into pelvic wall or lower 3rd of vagina

Question 6

Stage IIIA

Answer 6

Stage IIIA: invades lower 3rd of vagina but no extension into pelvic wall

Question 7

Stage IIIB

Answer 7

Stage IIIB: invades pelvic sidewall and/ or causes hydronephrosis or nonfunctioning kidney

Question 8

Stage IVB

Answer 8

Stage IVA: invades beyond true pelvis or mucosa of bladder or rectum (must be Bx proven); bullous edema of bladder or rectum does not count

Question 9

How does AJCC staging compare to FIGO?

Answer 9

In AJCC cervical cancer staging, the T stage corresponds to the FIGO stage, except for FIGO stage IVB. Node + patients are AJCC stage IIIB. Stage 0 exists in the AJCC but not in the FIGO system.

Question 10

What factors are predictive of pelvic nodal involvement in cervical cancer?

Answer 10

DOI, FIGO stage, tumor size, and LVSI (10% without vs. 25% with). It is controversial whether histologic subtype is an independent predictor for nodal involvement, although some studies show adenocarcinomas having higher rates of distant metastasis.

Question 11

Est pelvic LN based on DOI of cervical cancer

Answer 11

Risk of pelvic nodal involvement by DOI: ≤ 3 mm:

Question 12

Pelvic LN+ rates based on FIGO stage

Answer 12

Pelvic LN + rates for cervical cancer based on the FIGO stage: Stage IA1: 1% Stage IA2: 5% Stage IB: 15% Stage II: 30% Stage III: 50% Stage IVA: 60%

Question 13

P-A LN + rates for cervical cancer based on the FIGO stage:

Answer 13

Stage IA: 0% Stage IB: 5%– 8% Stage IIA: ∼ 10% Stage IIB: ∼ 15% Stage III: 30% Stage IVA: 40%

Question 14

What are the 5-yr OS rates based on the FIGO stage?

Answer 14

Stage IA: 93% Stage IB: 75%– 80% Stage IIA: 80% Stage IIB: 65%– 70% Stage IIIA: 35% Stage IIIB: 35%– 40% Stage IVA: 10% Stage IVB: 0%