staging cervical cancer

The process used to find out if cancer has spread (metastasized) within the cervix or to other parts of the body is called staging. The information gathered from the staging process is an important part in creating the best treatment plan. 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.

Regardless of where it spreads, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, cervical cancer that has spread to the lungs will be metastatic cervical cancer, not lung cancer. This is because the cancer cells in the lungs are actually cervical cancer cells. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

To learn the extent of the disease, your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissues. He or she may also order some of the following tests:

  • Chest X-rays: X-rays often can show whether cancer has spread to the lungs.

  • 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).

  • Molecular testing of the tumor: Sometimes, the doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

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.

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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.