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Cervical Cancer Treatment (PDQ®)

Stage Information for Cervical Cancer

Carcinoma of the cervix can spread via local invasion, the regional lymphatics, or bloodstream. Tumor dissemination is generally a function of the extent and invasiveness of the local lesion. While cancer of the cervix generally progresses in an orderly manner, occasionally a small tumor with distant metastasis is seen. For this reason, patients must be carefully evaluated for metastatic disease.

Pretreatment surgical staging is the most accurate method to determine the extent of disease,[1] but there is little evidence to demonstrate overall improved survival with routine surgical staging; the staging is usually performed only as part of a clinical trial. Pretreatment surgical staging in bulky but locally curable disease may be indicated in select cases when a nonsurgical search for metastatic disease is negative. If abnormal nodes are detected by computed tomography (CT) scan or lymphangiography, fine-needle aspiration should be negative before a surgical staging procedure is performed.

Tests and procedures to evaluate the extent of the disease include the following:

  • CT scan.
  • Positron emission tomography scan.
  • Cystoscopy.
  • Laparoscopy.
  • Chest x-ray.
  • Ultrasound.[2]
  • Magnetic resonance imaging.[2]

FIGO Stage Groupings and Definitions

The Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer have designated staging to define cervical cancer; the FIGO system is most commonly used.[3,4]

Table 1. Definitions of FIGO Stage Ia
Stage Description Illustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
bThe depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space invasion should not alter the staging.
I The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded).  
IA Invasive cancer identified only microscopically. (All gross lesions even with superficial invasion are Stage IB cancers.) Invasion is limited to measured stromal invasion with a maximum depth of 5 mmb and no wider than 7 mm.  
IA1 Measured invasion of stroma ≤3.0 mm in depth and ≤7.0 mm width.
Stage IA1 and IA2 cervical cancer; drawing shows a cross-section of the cervix and vagina. An inset shows cancer in the cervix that is up to 5 mm deep, but not more than 7 mm wide.
IA2 Measured invasion of stroma >3.0 mm and < 5.0 mm in depth and ≤ 7 mm width.
IB Clinical lesions confined to the cervix or preclinical lesions greater than stage IA.  
IB1 Clinical lesions no greater than 4 cm in size.
Stage IB1 and IB2 cervical cancer shown in three cross-section drawings of the cervix and vagina. An inset on the left shows stage IB1 cancer that is 7 mm wide and more than 5 mm deep. Drawing in the middle shows stage IB1 cancer that is smaller than 4 cm. Drawing on the right shows stage IB2 cancer that is larger than 4 cm.
IB2 Clinical lesions >4 cm in size.
Table 2. Definitions of FIGO Stage IIa
Stage Description Illustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
II The carcinoma extends beyond the uterus but not extended onto the pelvic wall or to the lower third of the vagina.  
IIA Involvement of up to the upper 2/3 of the vagina. No obvious parametrial involvement.
Stage II cervical cancer; drawing shows a cross-section of the uterus, cervix and vagina. In stages IIA1 and IIA2, cancer that is 4 cm is shown in the cervix and in the upper third of the vagina. In stage IIB, cancer is shown in the cervix, the upper two thirds of the vagina, and in the tissues around the uterus.
IIA1 Clinically visible lesion ≤4.0 cm.
IIA2 Clinically visible lesion >4.0 cm.
IIB Obvious parametrial involvement but not onto the pelvic sidewall.
Table 3. Definitions of FIGO Stage IIIa
Stage Description Illustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
 
III The carcinoma has extended onto the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumor and pelvic sidewall. The tumor involves the lower third of the vagina. All cases of hydronephrosis or nonfunctioning kidney should be included unless they are known to be due to other causes.  
IIIA Involvement of the lower vagina but no extension onto pelvic sidewall.
Stage IIIA cervical cancer; drawing shows a cross-section of the cervix and vagina. Cancer is shown in the cervix and in the full length of the vagina.
IIIB Extension onto the pelvic sidewall, or hydronephrosis/non-functioning kidney.
Stage IIIB cervical cancer; drawing shows cancer in the cervix, the vagina, and  the pelvic wall, blocking the ureter on the right. The uterus and kidneys are also shown.
Table 4. Definitions of FIGO Stage IVa
Stage Description Illustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
IV The carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.  
IVA Spread to adjacent pelvic organs.
Stage IVA cervical cancer; drawing and inset show that cancer has spread from the cervix to the bladder and rectal wall.
IVB Spread to distant organs.
Stage IVB cervical cancer; drawing shows the places in the body where stage IV cervical cancer may spread, including the lymph nodes, lung, liver, intestinal tract, cervix, abdominal wall, and bone. Also shown is an inset of cancer that has spread to a lymph node and through the blood to other parts of the body.

References

  1. Gold MA, Tian C, Whitney CW, et al.: Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group Study. Cancer 112 (9): 1954-63, 2008. [PUBMED Abstract]
  2. Epstein E, Testa A, Gaurilcikas A, et al.: Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound - a European multicenter trial. Gynecol Oncol 128 (3): 449-53, 2013. [PUBMED Abstract]
  3. FIGO Committee on Gynecologic Oncology: FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet 125 (2): 97-8, 2014. [PUBMED Abstract]
  4. Cervix uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 395-402.
  • Updated: April 17, 2015