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Cervical Cancer Treatment (PDQ®)

Patient Version
Last Modified: 04/19/2012

Stages of Cervical Cancer

Key Points for This Section


After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body.

The process used to find out if cancer has spread within the cervix or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Lymphangiogram: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
  • Pretreatment surgical staging: Surgery (an operation) is done to find out if the cancer has spread within the cervix or to other parts of the body. In some cases, the cervical cancer can be removed at the same time. Pretreatment surgical staging is usually done only as part of a clinical trial.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for cervical cancer:

Carcinoma in Situ (Stage 0)

In carcinoma in situ (stage 0), abnormal cells are found in the innermost lining of the cervix. These abnormal cells may become cancer and spread into nearby normal tissue.

Enlarge 1
Millimeters; drawing shows millimeters (mm) using everyday objects. A sharp pencil point shows 1 mm, a new crayon point shows 2 mm, and a new pencil-top eraser shows 5 mm. 1
Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.

Stage I

In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

  • Stage IA:
    Enlarge 2
    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. 2
    Stage IA1 and IA2 cervical cancer. A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. In stage IA1, the cancer is not more than 3 millimeters deep and not more than 7 millimeters wide. In stage IA2, the cancer is more than 3 but not more than 5 millimeters deep, and not more than 7 millimeters wide.
    A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. Stage IA is divided into stages IA1 and IA2, based on the size of the tumor.
    • In stage IA1, the cancer is not more than 3 millimeters deep and not more than 7 millimeters wide.
    • In stage IA2, the cancer is more than 3 but not more than 5 millimeters deep, and not more than 7 millimeters wide.
  • Stage IB is divided into stages IB1 and IB2.
    Enlarge 3
    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. 3
    Stage IB1 and IB2 cervical cancer. In stage IB1, the cancer can only be seen with a microscopic and is more than 5 mm deep or more than 7 mm wide OR the cancer can be seen without a microscope and is 4 cm or smaller. In stage IB2, the cancer is larger than 4 cm.
    • In stage IB1:
      • the cancer can only be seen with a microscope and is more than 5 millimeters deep and more than 7 millimeters wide; or
      • the cancer can be seen without a microscope and is 4 centimeters or smaller.
    • In stage IB2, the cancer can be seen without a microscope and is larger than 4 centimeters.

Stage II

Enlarge 4
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. 4
Stage II cervical cancer. Cancer has spread beyond the cervix but not to the pelvic wall or to the lower third of the vagina. In stages IIA1 and IIA2, cancer has spread beyond the cervix to the vagina. In stage IIA1, the tumor can be seen without a microscope and is 4 centimeters or smaller. In stage IIA2, the tumor can be seen without a microscope and is larger than 4 centimeters. In stage IIB, cancer has spread beyond the cervix to the tissues around the uterus.

In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.

  • Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus. Stage IIA is divided into stages IIA1 and IIA2, based on the size of the tumor.
    • In stage IIA1, the tumor can be seen without a microscope and is 4 centimeters or smaller.
    • In stage IIA2, the tumor can be seen without a microscope and is larger than 4 centimeters.
  • Stage IIB: Cancer has spread beyond the cervix to the tissues around the uterus.

Stage III

In stage III, cancer has spread to the lower third of the vagina, and/or to the pelvic wall, and/or has caused kidney problems. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

  • Stage IIIA:
    Enlarge 5
    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. 5
    Stage IIIA cervical cancer. Cancer has spread to the lower third of the vagina but not to the pelvic wall.
    Cancer has spread to the lower third of the vagina but not to the pelvic wall.
  • Stage IIIB:
    Enlarge 6
    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. 6
    Stage IIIB cervical cancer. Cancer has spread to the pelvic wall; and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). The drawing shows the ureter on the right blocked by the cancer. This blockage can cause the kidney to enlarge or stop working.
    • Cancer has spread to the pelvic wall; and/or
    • the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working.

Stage IV

In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.

  • Stage IVA:
    Enlarge 7
    Stage IVA cervical cancer; drawing and inset show that cancer has spread from the cervix to the bladder and rectal wall. 7
    Stage IVA cervical cancer. Cancer has spread to nearby organs, such as the bladder or rectum.
    Cancer has spread to nearby organs, such as the bladder or rectum.
  • Stage IVB:
    Enlarge 8
    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. 8
    Stage IVB cervical cancer. Cancer has spread to parts of the body away from the cervix, such as the liver, intestines, lungs, or bones.
    Cancer has spread to other parts of the body, such as the liver, lungs, bones, or distant lymph nodes.


Glossary Terms

biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
bladder (BLA-der)
The organ that stores urine.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone cancer (bone KAN-ser)
Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
centimeter (SEN-tih-MEE-ter)
A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
cervical (SER-vih-kul)
Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck. Cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the “neck”) of the uterus.
cervical cancer (SER-vih-kul KAN-ser)
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.
cervix (SER-vix)
The lower, narrow end of the uterus that forms a canal between the uterus and vagina.
chest x-ray (chest EX-ray)
An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
clinical trial (KLIH-nih-kul TRY-ul)
A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
contrast material (KON-trast muh-TEER-ee-ul)
A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
fine-needle aspiration biopsy (... NEE-dul AS-pih-RAY-shun BY-op-see)
The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
injection (in-JEK-shun)
Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser)
Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
kidney (KID-nee)
One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.
liver (LIH-ver)
A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
lung (lung)
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph (limf)
The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph vessel (limf ...)
A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphangiogram (lim-FAN-jee-oh-gram)
An x-ray of the lymphatic system. A dye is injected into a lymphatic vessel and travels throughout the lymphatic system. The dye outlines the lymphatic vessels and organs on the x-ray.
lymphatic system (lim-FA-tik SIS-tem)
The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
metastasis (meh-TAS-tuh-sis)
The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
microscope (MY-kroh-SKOPE)
An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
millimeter (MIH-luh-MEE-ter)
A measure of length in the metric system. A millimeter is one thousandth of a meter. There are 25 millimeters in an inch.
MRI
A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
pelvic wall (PEL-vik wawl)
The muscles and ligaments that line the part of the body between the hips.
primary tumor (PRY-mayr-ee TOO-mer)
The original tumor.
radio wave (RAY-dee-oh…)
A type of wave made when an electric field and a magnetic field are combined. Radio waves are being studied in the treatment of several types of cancer and other conditions. The radio waves are sent through needles inserted into tumor tissue and may kill cancer cells. Radio waves are also used in MRI to create detailed images of areas inside the body.
rectum (REK-tum)
The last several inches of the large intestine closest to the anus.
sonogram (SAH-noh-gram)
A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
stage (stayj)
The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 cervical carcinoma in situ (... SER-vih-kul KAR-sih-NOH-muh in SY-too)
Abnormal cells are found in the innermost lining of the cervix. These abnormal cells may become cancer and spread into nearby normal tissue. Also called cervical squamous intraepithelial neoplasia 3 and CIN 3.
stage I cervical cancer (... SER-vih-kul KAN-ser)
Cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found. In stage IA, a very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. Stage IA is divided into stages IA1 and IA2, based on the size of the tumor. In stage IA1, the cancer is not more than 3 millimeters deep and not more than 7 millimeters wide. In stage IA2, the cancer is more than 3 but not more than 5 millimeters deep, and not more than 7 millimeters wide. Stage IB is divided into stages IB1 and IB2. In stage IB1, (1) the cancer can only be seen with a microscope and is more than 5 millimeters deep and more than 7 millimeters wide; or (2) the cancer can be seen without a microscope and is 4 centimeters or smaller. In stage IB2, the cancer can be seen without a microscope and is larger than 4 centimeters.
stage II cervical cancer (... SER-vih-kul KAN-ser)
Cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread. In stage IIA, cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus. Stage IIA is divided into stages IIA1 and IIA2, based on the size of the tumor. In stage IIA1, the tumor can be seen without a microscope and is 4 centimeters or smaller. In stage IIA2, the tumor can be seen without a microscope and is larger than 4 centimeters. In stage IIB, cancer has spread beyond the cervix to the tissues around the uterus.
stage III cervical cancer (... SER-vih-kul KAN-ser)
Cancer has spread to the lower third of the vagina, and/or to the pelvic wall, and/or has caused kidney problems. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread. In stage IIIA, cancer has spread to the lower third of the vagina but not to the pelvic wall. In stage IIIB, (1) cancer has spread to the pelvic wall; and/or (2) the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working.
stage IV cervical cancer (... SER-vih-kul KAN-ser)
Cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found. In stage IVA, cancer has spread to nearby organs, such as the bladder or rectum. In stage IVB, cancer has spread to other parts of the body, such as the liver, lungs, bones, or distant lymph nodes.
staging (STAY-jing)
Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND)
A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
ureter (YER-eh-ter)
The tube that carries urine from the kidney to the bladder.
uterus (YOO-teh-rus)
The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called womb.
vagina (vuh-JY-nuh)
The muscular canal that goes from the uterus to the outside of the body. During birth, the baby passes through the vagina. Also called birth canal.
vein (vayn)
A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.

Table of Links

1http://www.cancer.gov/PublishedContent/MediaLinks/290492.html
2http://www.cancer.gov/PublishedContent/MediaLinks/290493.html
3http://www.cancer.gov/PublishedContent/MediaLinks/290494.html
4http://www.cancer.gov/PublishedContent/MediaLinks/290495.html
5http://www.cancer.gov/PublishedContent/MediaLinks/290496.html
6http://www.cancer.gov/PublishedContent/MediaLinks/290497.html
7http://www.cancer.gov/PublishedContent/MediaLinks/290498.html
8http://www.cancer.gov/PublishedContent/MediaLinks/290499.html