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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
StageDescriptionIllustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
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 ≤7.00 mm. Depth of invasion should 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.
IThe carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded). 
IAInvasive carcinoma, which can be diagnosed only by microscopy with deepest invasion ≤5 mm and largest extension ≥7 mm. 
IA1Measured stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm.
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.
IA2Measured stromal invasion of >3.0 mm and ≤5.0 mm with an extension of ≤7.0 mm.
IBClinically visible lesions limited to the cervix uteri or preclinical cancers greater than stage IAb. 
IB1Clinically visible lesion ≤4.0 cm in greatest dimension.
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.
IB2Clinically visible lesion >4.0 cm in greatest dimension.
Table 2. Definitions of FIGO Stage IIa
StageDescriptionIllustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
IICervical carcinoma invades beyond the uterus but not to the pelvic wall or to the lower third of the vagina. 
IIAWithout parametrial invasion.
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.
IIA1Clinically visible lesion ≤4.0 cm in greatest dimension.
IIA2Clinically visible lesion >4.0 cm in greatest dimension.
IIBWith obvious parametrial invasion.
Table 3. Definitions of FIGO Stage IIIa
StageDescriptionIllustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
bOn 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.
IIIThe tumor extends to the pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney.b 
IIIATumor involves lower third of the vagina with no extension to the pelvic wall.
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.
IIIBExtension to the pelvic wall and/or hydronephrosis or nonfunctioning 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
StageDescriptionIllustration
FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]
IVThe 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. 
IVASpread of the growth to adjacent organs.
Stage IVA cervical cancer; drawing and inset show that cancer has spread from the cervix to the bladder and rectal wall.
IVBSpread 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. Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105 (2): 103-4, 2009. [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: December 4, 2014