Cervical Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Cervical Cancer
Carcinoma of the cervix can spread via local invasion, the regional lymphatics, or bloodstream. Tumor dissemination is generally a function of the extent and invasiveness of the local lesion. While cancer of the cervix generally progresses in an orderly manner, occasionally a small tumor with distant metastasis is seen. For this reason, patients must be carefully evaluated for metastatic disease.
Pretreatment surgical staging is the most accurate method to determine the extent of disease, but there is little evidence to demonstrate overall improved survival with routine surgical staging; the staging is usually performed only as part of a clinical trial. Pretreatment surgical staging in bulky but locally curable disease may be indicated in select cases when a nonsurgical search for metastatic disease is negative. If abnormal nodes are detected by computed tomography (CT) scan or lymphangiography, fine-needle aspiration should be negative before a surgical staging procedure is performed.
Tests and procedures to evaluate the extent of the disease include the following:
- CT scan.
- Positron emission tomography scan.
- Chest x-ray.
- Magnetic resonance imaging.
FIGO Stage Groupings and Definitions
The Féderation Internationale de Gynécologie et d'Obstétrique (FIGO) and the American Joint Committee on Cancer have designated staging to define cervical cancer; the FIGO system is most commonly used.[3,4]
Table 1. Definitions of FIGO Stage Ia
|FIGO = Féderation Internationale de Gynécologie et d'Obstétrique.|
|a Adapted from FIGO committee on gynecologic oncology.|
|b All macroscopically visible lesions - even with superficial invasion - are allotted to stage IB carcinomas. Invasion is limited to a measured stromal invasion with a maximal depth of 5.00 mm and a horizontal extension of ≤7.00 mm. Depth of invasion should be ≤5.00 mm taken from the base of the epithelium of the original tissue - superficial or glandular. The depth of invasion should always be reported in mm, even in those cases with "early (minimal) stromal invasion" (~1 mm). The involvement of vascular/lymphatic spaces should not change the stage allotment.|
|I||The carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded).|| |
|IA||Invasive carcinoma, which can be diagnosed only by microscopy with deepest invasion ≤5 mm and largest extension ≥7 mm.|| |
|Measured stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm.|
|IA2||Measured stromal invasion of >3.0 mm and ≤5.0 mm with an extension of ≤7.0 mm.|
|IB||Clinically visible lesions limited to the cervix uteri or preclinical cancers greater than stage IAb.|| |
|Clinically visible lesion ≤4.0 cm in greatest dimension.|
|IB2||Clinically visible lesion >4.0 cm in greatest dimension.|