Staging is the process physicians use to assess the size and location of a patient’s cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options.
The FIGO (International Federation of Gynecology and Obstetrics) system is used to stage cervical cancer. The FIGO system involves assigning a numerical stage (0 through IV) to a patient’s cancer based on physical examination and other diagnostic exams, such as cystoscopy or proctoscopy.
The stage of a cancer describes its size and the extent to which it has spread. The staging system ranges from stage 0 (early stage) to stage IV (late stage).
Stage 0 or "in situ:" The term "in situ" literally means "in place." Stage 0 describes cancer that has only been found in the layer of cells lining the cervix. The cancer has not invaded the deeper tissues of the cervix. Treatment options are the same as those used for pre-cancerous conditions and include cauterization, cone biopsy, cryosurgery, or laser surgery. A simple hysterectomy may be performed if the woman does not want to have children in the future. Stage 0 cancers can be effectively treated, but patients should be closely monitored by physicians for any possible recurrence.
Stage I: This stage describes cancer that has spread from the lining of the cervix into the deeper connective tissue of the cervix. Stage I cancer is still confined to the uterus.
Stage IA: This is the earliest form of stage I cancer. Only a small amount of cancer is visible upon microscopic examination. The treatment for stage IA cancer is simple hysterectomy. However, if the cancer more than 3 millimeters (approximately 1/8 inch) or has invaded the blood vessels or lymph vessels, then a radical hysterectomy may be needed. Radiation therapy may be used after surgery if the cancer cells extend to the edges of the organs that were removed. Recent clinical trials show that combined radiation and chemotherapy with cisplatin (brand name, Platinol) and other drugs is more effective than radiation alone.
Stage IA1: The area of invasion is less than 3 millimeters (approximately 1/8 inch) deep and less than 7 millimeters (approximately 1/3 inch) wide.
Stage IA2: The area of invasion is between 3 mm (millimeters) and 5 mm (approximately 1/5 inch) deep, and less than 7 mm (approximately 1/3 inch) wide.
Stage IB: This stage includes cancers that can be seen without a microscope. It also includes cancers seen only with a microscope that have spread deeper than 5 mm (approximately 1/5 inch) into connective tissue of the cervix or are wider than 7 mm. One treatment option for stage IB cancer is radical hysterectomy with selective para-aortic and radical bilateral (both sides) pelvic lymph node removal. Radiation therapy may be used after surgery if the cancer cells extend to the edges of the organs that were removed or if any of the removed lymph nodes are found to contain cancer. The second treatment option for stage IB cancer is high-dose internal and external radiation therapy. Studies show that combined radiation and chemotherapy with cisplatin (brand name, Platinol) and other drugs is more effective than radiation alone. Cure rates are similar for both treatment options (between 85% and 90%).
Stage IB1: This is a stage IB cancer that is no larger than 4 centimeters (approximately 1 and 3/5 inches).
Stage IB2: This is a stage IB cancer that is larger than 4 centimeters (approximately 1 and 3/5 inches).
Stage II: This stage describes cancer that has spread beyond the cervix to nearby area but is still inside the pelvic area.
Stage IIA: This stage includes cancer that has spread beyond the cervix to the upper portion of the vagina. However, the cancer does not involve the lower third of the vagina. One treatment option for stage IIA cancer is high-dose internal and external radiation therapy. Studies show that combined radiation and chemotherapy with cisplatin (brand name, Platinol) and other drugs is more effective than radiation alone. The second treatment option is radical hysterectomy with selective para-aortic and radical bilateral (both sides) pelvic lymph node dissection. Cure rates are similar for both treatment options (between 75% and 80%).
Stage IIB: This stage includes cancer that has spread to the tissue next to the cervix (the parametrial tissue). Studies show that combined radiation and chemotherapy with cisplatin (brand name, Platinol) and other drugs is more effective than radiation alone. The treatment for stage IIB cancer is combined internal and external radiation therapy. The five-year survival rate for stage IIB cancer is approximately 65%.
Stage III: This stage describes cancer that has spread to the lower part of the vagina or the pelvic wall. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). Treatment for stage III cancer is radiation therapy and chemotherapy with cisplatin (brand name, Platinol) and other drugs. Studies show that combined radiation and chemotherapy is more effective than radiation alone, which was once the standard treatment for this stage of cancer.
Stage IIIA: This stage includes cancer that has spread to the lower third of the vagina but has not spread to the pelvic wall.
Stage IIIB: This stage includes cancer that extends to the pelvic wall and/or blocks urine flow to the bladder.
Stage IV: This is the most advanced stage of cervical cancer. The cancer has spread (metastasized) to other parts of the body.
Stage IVA: This stage includes cancer that has spread to the bladder or rectum—organs close to the cervix. The treatment for Stage IVA cancer is the same as for Stage III cancer: combined radiation therapy and chemotherapy with cisplatin (brand name, Platinol) and other drugs. Studies show that combined radiation and chemotherapy is more effective than radiation alone, which was once the standard treatment for this stage of cancer.
Stage IVB: This stage includes cancer that has spread to distant organs beyond the pelvic area, such as the lungs. Stage IVB cancer is not considered curable. Treatment options focus on relieving cancer symptoms and extending survival time. Radiation therapy and/or chemotherapy may be used. In addition, patients may be eligible to participate in clinical trials that test new therapies for this stage of cancer.
Updated: June 2, 2008
