Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. The stage is an important factor in determining treatment options. For patients with cervical cancer, stage is assigned based on a physical exam and some of the tests described previously. Surgery is not necessary to determine the stage.
Stage 0
Description
- “Carcinoma in situ.” Inner layer of cervix contains abnormal, but non-invasive cells.
Treatment
- Squamous Cell Carcinoma-in situ (CIS): Laser surgery, cryosurgery, LEEP, or cold knife conization. Persistent CIS may be treated with hysterectomy.
- Adenocarcinoma-in situ (AIS): LEEP, cold knife conization, or hysterectomy
Stage Ia
Description
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- Stage I: Carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded).
- Stage IA:Invasive carcinoma that can be diagnosed only with microscopy, with maximum depth of invasion <5 mm.
- Stage IA1:Stromal invasion <3 mm in depth.
- Stage IA2: Stromal invasion ≥3 mm and <5 mm in depth.
- Stage IA:Invasive carcinoma that can be diagnosed only with microscopy, with maximum depth of invasion <5 mm.
- Stage I: Carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded).
Treatment
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- Stage IA1:Cone biopsy only, hysterectomy, or trachelectomy. Cold knife conization with lymph node assessment or (simple or radical) hysterectomy with lymph node assessment for patients with high-risk features
- Stage IA2: Cold knife conization with lymph node assessment, (simple or radical) hysterectomy with lymph node assessment, internal and/or external radiation therapy, or a radical trachelectomy.
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Stage Ib
Description
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- Stage IB: Invasive carcinoma confined to the uterine cervix, with measured deepest invasion ≥5 mm.
- Stage IB1: Tumor measures <2 cm in greatest dimension.
- Stage IB2: Tumor measures ≥2 cm and <4 cm in greatest dimension.
- Stage IB3: Tumor measures ≥4 cm in greatest dimension.
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Treatment
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- Stage IB1/IB2: Radical hysterectomy with lymph node assessment, internal and/or external radiation therapy, or a radical trachelectomy.
- Stage IB3: Chemoradiation, in rare cases, chemotherapy followed by a radical hysterectomy.
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Stage IIa
Description
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- Stage II: Carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall.
- Stage IIA: Limited to the upper two-thirds of the vagina without parametrial involvement.
- Stage IIA1: Tumor measures <4 cm in greatest dimension.
- Stage IIA2: Tumor measures ≥4 cm in greatest dimension.
- Stage II: Carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall.
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Treatment
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- Stage IIA1:Radical hysterectomy with lymph node assessment internal and or external radiation.
- Stage IIA2: Chemoradiation (internal radiation, external radiation, and chemotherapy).
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Stage IIb
Description
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- With parametrial involvement but not up to the pelvic wall.
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Treatment
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- Chemoradiation (internal radiation, external radiation, and chemotherapy).
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Stage IIIa
Description
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- Stage III: Carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or para-aortic lymph nodes.
- Stage IIIA: Involves the lower third of the vagina, with no extension to the pelvic wall.
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Treatment
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- Chemoradiation (internal radiation, external radiation, and chemotherapy)
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Stage IIIb
Description
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- Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney from tumor.
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Treatment
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- Chemoradiation (internal radiation, external radiation, and chemotherapy)
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Stage IIIc
Description
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- Stage IIIC: Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent.
- Stage IIIC1: Pelvic lymph node metastasis only.
- Stage IIIC2: Para-aortic lymph node metastasis.
- Stage IIIC1: Pelvic lymph node metastasis only.
- Stage IIIC: Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent.
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Treatment
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- Chemoradiation (internal radiation, external radiation, and chemotherapy)
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Stage IVa
Description
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- Stage IV: Carcinoma has extended beyond the true pelvis or has involved (biopsy-proven) the mucosa of the bladder or rectum.
- Stage IVA: Spread to adjacent pelvic organs.
- Stage IV: Carcinoma has extended beyond the true pelvis or has involved (biopsy-proven) the mucosa of the bladder or rectum.
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Treatment
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- Chemoradiation (internal radiation, external radiation, and chemotherapy).
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Stage IVb
Description
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- Spread to distant organs.
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Treatment
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- Chemotherapy with targeted therapy and immunotherapy, clinical trials occasionally radiation to relieve symptoms.
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