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Cervical Cancer Staging

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, the doctor may order some of the following tests:

  • Chest X-rays: X-rays often can show whether cancer has spread to the lungs.
  • CT scan: An X-ray machine linked to a computer takes a series of detailed pictures of your organs. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. The contrast material makes abnormal areas easier to see.
  • MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
  • PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.

For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (FIGO) is used. The stage is based on where cancer is found. These are the stages of invasive cervical cancer:

  • Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix.

    • Stage IA: There is a very small amount of cancer, and it can be seen only under a microscope. It has not spread to nearby lymph nodes nor to any distant sites.

      • Stage IA1: The cancerous area is less than 3 millimeters (mm) in depth.

      • Stage IA2: The cancerous area is between 3 mm to less than 5 mm in depth. 

    • Stage IB: This includes stage I cancer that has spread deeper than 5 mm (about 1/5 inch) but is still limited to the cervix. It has not spread to nearby lymph nodes nor to any distant sites.

      • Stage IB1: The tumor is 5 mm or greater in depth and less than 2 centimeters (cm) wide.

      • Stage IB2: The tumor is 2 cm or greater in depth and less than 4 cm wide.

      • Stage IB3: The tumor is 4 cm or more in width.

  • Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall.

    • Stage IIA: The cancer has grown beyond the cervix and uterus but has not spread into the tissues next to the cervix (called the parametria). It has not spread to nearby lymph nodes nor to any distant sites.

      • Stage IIA1: The tumor is less than 4 cm wide.

      • Stage IIA2: The tumor is 4 cm or more in width. 

    • Stage IIB: The cancer has grown beyond the cervix and uterus and has spread into the tissues next to the cervix (the parametria). It has not spread to nearby lymph nodes nor to any distant sites.

  • Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well.

    • Stage IIIA: The cancer has spread to the lower part of the vagina but not the walls of the pelvis. It has not spread to nearby lymph nodes nor to any distant sites.

    • Stage IIIB: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters causing kidney problems (called hydronephrosis). It has not spread to nearby lymph nodes nor to any distant sites.

    • Stage IIIC: The cancer can be any size.

      • Stage IIIC1: The cancer has spread to nearby pelvic lymph nodes.

      • Stage IIIC2: The cancer has spread to para-aortic lymph nodes.

  • Stage IV: The tumor invades the bladder or rectum. Or the cancer has spread to other parts of the body.

    • Stage IVA: The cancer has spread to the bladder or rectum or it is growing out of the pelvis.

    • Stage IVB: The cancer has spread to distant organs outside the pelvic area, such as distant lymph nodes, lungs or bones.

  • Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

Medical Oncologist - Cervical Cancer