Questions About Cancer? 1-800-4-CANCER

Cervical Cancer Treatment (PDQ®)

Health Professional Version
Last Modified: 08/15/2014

Stage Information for Cervical Cancer

FIGO Stage Groupings and Definitions

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 
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.
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.
IB2Clinically visible lesion >4.0 cm in greatest dimension.

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.

Table 2. Definitions of FIGO Stage IIa
Stage Description Illustration 
IICervical carcinoma invades beyond the uterus but not to the pelvic wall or to the lower third of the vagina.
IIAWithout parametrial invasion.
IIA1Clinically visible lesion ≤4.0 cm in greatest dimension.
IIA2Clinically visible lesion >4.0 cm in greatest dimension.
IIBWith obvious parametrial invasion.

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]

Table 3. Definitions of FIGO Stage IIIa
Stage Description Illustration 
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.
IIIBExtension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney.

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.

Table 4. Definitions of FIGO Stage IVa
Stage Description Illustration 
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.
IVBSpread to distant organs.

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.
aAdapted from FIGO committee on gynecologic oncology.[3]

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.