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Gynaecology: Cervix — para-aortic nodal staging and management

Free question published 10 October 2026

GynaecologyCervix — para-aortic nodal staging and management

A 55-year-old woman with FIGO 2018 stage IIIB squamous cervical cancer is staged with PET-CT, which shows an FDG-avid 14 mm para-aortic lymph node at the level of the left renal vein, with avid pelvic nodes, and no distant disease. Renal function is normal. What does this para-aortic finding most appropriately change in her management?

  1. AShe is offered pelvic radiotherapy alone with no chemotherapy because of the nodal burden
  2. BShe is reclassified as stage IIIC2 and offered extended-field chemoradiotherapy covering the para-aortic region plus brachytherapy
  3. CShe is reclassified as stage IVB and offered palliative chemotherapy only
  4. DShe is offered radical hysterectomy with para-aortic lymphadenectomy
  5. EShe is reclassified as stage IIIC1 and offered standard pelvic chemoradiotherapy

Why B is correct

Under FIGO 2018, para-aortic node involvement is stage IIIC2. Para-aortic disease remains locoregional and is treated with curative intent using extended-field (pelvic plus para-aortic) concurrent chemoradiotherapy followed by image-guided brachytherapy, as informed by trials such as Morris et al that included extended-field fields.

And why the others are not

  • AIncorrect. Concurrent cisplatin chemoradiotherapy improves survival and should not be omitted in this fit patient.
  • CIncorrect. Para-aortic nodal disease is stage IIIC2, not IVB; it is locoregional and treated with curative-intent extended-field chemoradiotherapy.
  • DIncorrect. The guideline advises avoiding combining radical surgery and radiotherapy; bulky node-positive disease is treated with definitive chemoradiotherapy.
  • EIncorrect. IIIC1 denotes pelvic nodes only; a para-aortic node assigns IIIC2 and mandates extended-field coverage.

Source Revised FIGO 2018 staging for carcinoma of the cervix uteri — Bhatla N, et al. Implications of the revised cervical cancer FIGO staging system. Indian Journal of Medical Research, 2021 (reviewing the FIGO 2018 revision, Bhatla et al, Int J Gynecol Obstet 2019).

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