Cervical Cancer Stage / Stages of Cervical Cancer

(Lifted from the National Cancer Institute)

KEY POINTS

  • 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.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • Abnormal cells may form in the lining of the cervix (carcinoma in situ).
  • The following stages are used for cervical cancer:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV

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:

  • 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.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • 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).
  • 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. This picture can be printed to be looked at later.
  • 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.
  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.
  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be checked under a microscope for signs of disease.
  • 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.

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.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if cervical cancer spreads to the lung, the cancer cells in the lung are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

Abnormal cells may form in the lining of the cervix (carcinoma in situ).

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

The following stages are used for cervical cancer:

Cervical Cancer Stage I

In stage I, cancer has formed and is found in the cervix only.

Stage I is divided into stages IA and IB, based on the size of the tumor and the deepest point of tumor invasion.

  • Stage IA: Stage IA is divided into stages IA1 and IA2, based on the deepest point of tumor invasion.
    • In stage IA1, a very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The deepest point of tumor invasion is 3 millimeters or less.
    • In stage IA2, a very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The deepest point of tumor invasion is more than 3 millimeters but not more than 5 millimeters.
    ENLARGEMillimeters; 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.
    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 IB: Stage IB is divided into stages IB1, IB2, and IB3, based on the size of the tumor and the deepest point of tumor invasion.
    • In stage IB1, the tumor is 2 centimeters or smaller and the deepest point of tumor invasion is more than 5 millimeters.
    • In stage IB2, the tumor is larger than 2 centimeters but not larger than 4 centimeters.
    • In stage IB3, the tumor is larger than 4 centimeters.
    ENLARGEDrawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler.
    Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

Cervical Cancer Stage II

In stage II, cancer has spread to the upper two-thirds of the vagina or to the tissue around the uterus.

Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.

  • Stage IIA: Cancer has spread from the cervix to the upper two-thirds of the vagina but has not spread to the tissue around the uterus. Stage IIA is divided into stages IIA1 and IIA2, based on the size of the tumor.
    • In stage IIA1, the tumor is 4 centimeters or smaller.
    • In stage IIA2, the tumor is larger than 4 centimeters.
  • Stage IIB: Cancer has spread from the cervix to the tissue around the uterus.

Cervical Cancer 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, and/or involves lymph nodes.

Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread.

  • Stage IIIA: Cancer has spread to the lower third of the vagina but has not spread to the pelvic wall.
  • Stage IIIB: Cancer has spread to the pelvic wall; and/or the tumor has become large enough to block one or both ureters or has caused one or both kidneys to get bigger or stop working.
  • Stage IIIC: Stage IIIC is divided into stages IIIC1 and IIIC2, based on the spread of cancer to the lymph nodes.
    • In stage IIIC1, cancer has spread to lymph nodes in the pelvis.
    • In stage IIIC2, cancer has spread to lymph nodes in the abdomen near the aorta.

Cervical Cancer Stage IV

In stage IV, cancer has spread beyond the pelvis, or has spread to the lining of the bladder or rectum, or has spread to other parts of the body.

Stage IV is divided into stages IVA and IVB, based on where the cancer has spread.

  • Stage IVA: Cancer has spread to nearby organs, such as the bladder or rectum.
  • Stage IVB: Cancer has spread to other parts of the body, such as the liver, lungs, bones, or distant lymph nodes.

Recurrent Cervical Cancer

Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the cervix or in other parts of the body.