Cervical Cancer

Staging of Cervical Cancer

“Staging” is a method that has been developed to describe the extent of cancer growth. The stage of cervical cancer describes the tumor’s:

• Size
• Depth of penetration within the cervix
• Spread within and beyond the cervix

Staging allows the physician to customize cancer treatment and to predict how a patient will fare over time. In general, the lower the stage, the better the person’s prognosis (expected outcome).

The physician uses all available findings to choose a stage that best describes the woman’s condition.

Cervical cancer is staged by information that is obtained through:

• Biopsy (removal of tissue for examination)
• Information gathered from the pathology report that accompanies a biopsy
• Cystoscopy (visual examination of the urinary tract with a camera-like instrument called an endoscope)
• Abdominal ultrasound (which uses high-frequency sound waves to produce an image of the inner body)
• Computed tomography (CT) scan (a computer-assisted technique that produces cross-sectional images of the body)
• Magnetic resonance imaging (or MRI, which uses powerful magnets to create finely detailed images of body tissue)

Staging With The Figo System

Cervical cancer staging is usually described in terms of the FIGO system, a staging scheme developed by the International Federation of Gynecology and Obstetrics. The FIGO classifications are grouped within basic stages labeled stage 0 through stage IV (0-4):

• Stage 0 – Carcinoma in situ. Tumor is present only in the epithelium (cells lining the cervix) and has not invaded deeper tissues.
• Stage I – Invasive cancer with tumor strictly confined to the cervix.
  • Stage IA – In this earliest form of stage I, a very small amount of tumor can be seen under a microscope.
  • Stage IA1 – Tumor has penetrated an area less than 3 millimeters deep and less than 7 millimeters wide.
  • Stage IA2 – Tumor has penetrated an area 3 to 5 millimeters deep and less than 7 millimeters wide.
  • Stage IB – This stage includes tumors that can be seen without a microscope. It also includes tumors that cannot be seen without a microscope but that are more than 7 millimeters wide and have penetrated more than 5 millimeters of connective cervical tissue.
  • Stage IB1 – Tumor that is no bigger than 4 centimeters.
  • Stage IB2 – Tumor that is bigger than 4 centimeters. Tumor has spread to organs and tissues outside the cervix but is still limited to the pelvic area.
• Stage II – Invasive cancer with tumor extending beyond the cervix and/or the upper two-thirds of the vagina, but not onto the pelvic wall.
  • Stage IIA – Tumor has spread beyond the cervix to the upper part of the vagina.
  • Stage IIB – Tumor has spread to the tissue next to the cervix.
• Stage III – Invasive cancer with tumor spreading to the lower third of the vagina or onto the pelvic wall; tumor may be blocking the flow of urine from the kidneys to the bladder.
  • Stage IIIA – Tumor has spread to the lower third of the vagina.
  • Stage IIIB – Tumor has spread to the pelvic wall and/or blocks the flow of urine from the kidneys to the bladder.
• Stage IV – Invasive cancer with tumor spreading to other parts of the body. This is the most advanced stage of cervical cancer.
  • Stage IVA – Tumor has spread to organs located near the cervix, such as the bladder or rectum.
  • Stage IVB – Tumor has spread to parts of the body far from the cervix.

The lower the stage number, the less the cancer has grown and spread. For example, a “stage I” cervical cancer is relatively small and has not yet spread beyond the pelvic area. By contrast, a “stage IV” cancer is much more serious, as it has already spread to the lymph nodes (the body’s drainage system) as well as to other locations.