Note: This Stage Information section has been updated to include information from the seventh edition (2010) of the American Joint Committee on Cancer’s AJCC Cancer Staging Manual. The PDQ Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging categories to determine whether additional changes need to be made to other parts of the summary. Any necessary changes will be made as soon as possible.

Cervical carcinoma has its origins at the squamous-columnar junction whether in the endocervical canal or on the portion of the cervix. The precursor lesion is dysplasia or carcinoma in situ (cervical intraepithelial neoplasia [CIN]), which can subsequently become invasive cancer. This process can be quite slow. Longitudinal studies have shown that in untreated patients with in situ cervical cancer, 30% to 70% will develop invasive carcinoma over a period of 10 to 12 years. However, in about 10% of patients, lesions can progress from in situ to invasive in a period of less than 1 year. As it becomes invasive, the tumor breaks through the basement membrane and invades the cervical stroma. Extension of the tumor in the cervix may ultimately manifest as ulceration, exophytic tumor, or extensive infiltration of underlying tissue including bladder or rectum.

In addition to local invasion, carcinoma of the cervix can spread via 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] Because there is little evidence to demonstrate overall improved survival with routine surgical staging, the staging usually should be 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 scan or lymphangiography, fine-needle aspiration should be negative before a surgical staging procedure is performed.

Definitions of TNM and FIGO

The American Joint Committee on Cancer (AJCC) and the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) have designated staging to define cervical cancer.[2,3] The definitions of the AJCC’s T, N, and M categories correspond to the stages accepted by FIGO. Both systems are included for comparison.

Table 1. Primary Tumor (T)^a

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*TNM Categories*	*FIGO Stages*
TX		Primary tumor cannot be assessed.
T0		No evidence of primary tumor.
Tis^b		Carcinoma in situ (preinvasive carcinoma).
T1	I	Cervical carcinoma confined to uterus (extension to corpus should be disregarded).
T1a^c	IA	Invasive carcinoma diagnosed only by microscopy. Stromal invasion with a maximum depth of 5.0 mm measured from the base of the epithelium and a horizontal spread of ≤7.0 mm. Vascular space involvement, venous or lymphatic, does not affect classification.
T1a1	IA1	Measured stromal invasion ≤3.0 mm in depth and ≤7.0 mm in horizontal spread.
T1a2	IA2	Measured stromal invasion >3.0 mm and ≤5.0 mm with a horizontal spread of ≤7.0 mm.
T1b	IB	Clinically visible lesion confined to the cervix or microscopic lesion >T1a/IA2.
T1b1	IB1	Clinically visible lesion ≤4.0 cm in greatest dimension.
T1b2	IB2	Clinically visible lesion >4.0 cm in greatest dimension.
T2	II	Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina.
T2a	IIA	Tumor without parametrial invasion.
T2a1	IIA1	Clinically visible lesion ≤4.0 cm in greatest dimension.
T2a2	IIA2	Clinically visible lesion >4.0 cm in greatest dimension.
T2b	IIB	Tumor with parametrial invasion.
T3	III	Tumor extends to pelvic wall and/or involves lower third of vagina, and/or causes hydronephrosis or nonfunctioning kidney.
T3a	IIIA	Tumor involves lower third of vagina, no extension to pelvic wall.
T3b	IIIB	Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney.
T4	IVA	Tumor invades mucosa of bladder or rectum, and/or extends beyond true pelvis (bullous edema is not sufficient to classify a tumor as T4).

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
^aReprinted with permission from AJCC: 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.
^bFIGO no longer includes stage 0 (Tis).
^cAll macroscopically visible lesions–even with superficial invasion–are T1b/IB.

Table 2. Regional Lymph Nodes (N)^a

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*TNM Categories*	*FIGO Stages*
NX		Regional lymph nodes cannot be assessed.
N0		No regional lymph node metastasis.
N1	IIIB	Regional lymph node metastasis.

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
^aReprinted with permission from AJCC: 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.

Table 3. Distant Metastasis (M)^a

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*TNM Categories*	*FIGO Stages*
M0		No distant metastasis.
M1	IVB	Distant metastasis (including peritoneal spread, involvement of supraclavicular, mediastinal, or para-aortic lymph nodes, lung, liver, or bone).

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
^aReprinted with permission from AJCC: 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.

Table 4. Anatomic Stage/Prognostic Groups (FIGO 2008)^a

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Stage	T	N	M
0^b	Tis	N0	M0
I	T1	N0	M0
IA	T1a	N0	M0
IA1	T1a1	N0	M0
IA2	T1a2	N0	M0
IB	T1b	N0	M0
IB1	T1b1	N0	M0
IB2	T1b2	N0	M0
II	T2	N0	M0
IIA	T2a	N0	M0
IIA1	T2a1	N0	M0
IIA2	T2a2	N0	M0
IIB	T2b	N0	M0
III	T3	N0	M0
IIIA	T3a	N0	M0
IIIB	T3b	Any N	M0
IIIB	T1–3	N1	M0
IVA	T4	Any N	M0
IVB	Any T	Any N	M1

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
^aReprinted with permission from AJCC: 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.
^bFIGO no longer includes stage 0 (Tis).

Table 5. Carcinoma of the Cervix Uteri^a

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Stage
I	The carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded).
IA	Invasive carcinoma, which can be diagnosed only by microscopy with deepest invasion ≤5 mm and largest extension ≥7 mm.
IA1	Measured stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm.
IA2	Measured stromal invasion of >3.0 mm and not >5.0 mm with an extension of not >7.0 mm.
IB	Clinically visible lesions limited to the cervix uteri or preclinical cancers greater than stage IA.^b
IB1	Clinically visible lesion ≤4.0 cm in greatest dimension.
IB2	Clinically visible lesion >4.0 cm in greatest dimension.
II	Cervical carcinoma invades beyond the uterus but not to the pelvic wall or to the lower third of the vagina.
IIA	Without parametrial invasion.
IIA1	Clinically visible lesion ≤4.0 cm in greatest dimension.
IIA2	Clinically visible lesion >4.0 cm in greatest dimension.
IIB	With obvious parametrial invasion.
III	The tumor extends to the pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney.^c
IIIA	Tumor involves lower third of the vagina with no extension to the pelvic wall.
IIIB	Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney.
IV	The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV.
IVA	Spread of the growth to adjacent organs.
IVB	Spread to distant organs.

^aAdapted from FIGO Committee on Gynecologic Oncology.[3]
^bAll macroscopically visible lesions—even with superficial invasion—are allotted to stage IB carcinomas. Invasion is limited to a measured stromal invasion with a maximal depth of 5.00 mm and a horizontal extension of not >7.00 mm. Depth of invasion should not be >5.00 mm taken from the base of the epithelium of the original tissue—superficial or glandular. The depth of invasion should always be reported in mm, even in those cases with "early (minimal) stromal invasion" (~1 mm).
The involvement of vascular/lymphatic spaces should not change the stage allotment.
^cOn rectal examination, there is no cancer-free space between the tumor and the pelvic wall. All cases with hydronephrosis or nonfunctioning kidney are included, unless they are known to be the result of another cause.

References

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]
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.
Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105 (2): 103-4, 2009. [PUBMED Abstract]

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