434 Obstetrics and Gynecology Board Review •••
❍ Examination under anesthesia reveals a 3 cm in diameter cervical carcinoma with left parametrial
involvement not extending to the pelvic wall. The remainder of the staging evaluation is unremarkable.
To what stage is this patient’s tumor assigned?
Stage IIB. According to the 2009 FIGO staging modifications, lesions with clinical involvement of the
parametrium but not reaching the sidewall is stage IIB.
❍ For the above patient, if her IVP had revealed hydronephrosis, to what stage would her tumor is assigned?
Stage IIIB classified as either tumor extension to the pelvic sidewall or hydronephrosis or a nonfunctioning kidney.
❍ If this patient’s cystoscopy had identified bullous edema, what should her stage have been?
It would remain stage IIIB. Bullous edema without pathologic confirmation of malignancy does not permit
assignment to stage IVA.
❍ Are cystoscopy and proctoscopy necessary in the staging of all patients with cervical cancer?
They may be omitted in the staging of asymptomatic patients with early disease (typically IIA or lower) for whom
these studies are rarely abnormal.
❍ What is the incidence of pelvic and para-aortic lymph node metastasis for stage IB cervical cancer?
Approximately 15% to 20% and about 2%, respectively.
❍ For stage I cervical cancer, how does tumor size >4 cm affect the incidence of pelvic lymph node metastasis?
When compared with smaller lesions, an approximately threefold increase has been demonstrated.
❍ What lymph node group is most frequently involved with metastatic cervical cancer?
In most series, the external iliac group is most commonly involved followed next by the obturator group.
❍ A colposcopically directed cervical biopsy from a 25-year-old G0P0 reveals a small focus of microinvasive
squamous cell carcinoma. The resection margin is positive for carcinoma in situ. What is the next step in
this patient’s management?
Cervical cone biopsy to establish the full extent of invasion.
❍ A patient underwent conization with a FIGO stage IA1 squamous cell cancer and Society of Gynecologic
Oncologists (SGO) criteria for microinvasion but with surgical margins are free of cancer. Does she need
any further treatment?
Patient with FIGO stage IA1 and SGO criteria for microinvasion could be treated conservatively with simple
hysterectomy, or of continued fertility is desired conization only, provided surgical margins are free of cancer.
❍ For the above patient, final pathology shows invasion extending 2 mm below the basement membrane with
a width of 4 mm. No lymphovascular space involvement is present, and the margins are free of involvement.
What is this patient’s stage, and what are her therapeutic options?
Stage IA1. The SGO defines microinvasion as stromal invasion of 3 mm or less below the basement membrane
without lymphovascular space involvement. For patients who desire preservation of fertility, most authorities agree
that the risk of recurrence is very low, and that no additional therapy is necessary. If fertility is not desired, simple
hysterectomy is recommended.