The process of finding out how far the cancer has spread is called staging. Information from exams and diagnostic tests is used to determine the size of the tumor, how deeply the tumor has invaded tissues within and around the cervix, and the spread to lymph nodes or distant organs (metastasis). This is an important process because the stage of the cancer is the key factor in selecting the right treatment plan.

A staging system is a way for members of the cancer care team to summarize the extent of a cancer's spread. The 2 systems used for staging most types of cervical cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM staging system, are very similar. They both classify cervical cancer on the basis of 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). The system described below is the most recent AJCC system, which went into effect January 2010. Any differences between the AJCC system and the FIGO system are explained in the text.

This system classifies the disease in stages 0 through IV. It is based on clinical staging rather than surgical staging. This means that the extent of disease is evaluated by the doctor's physical examination and a few other tests that are done in some cases, such as cystoscopy and proctoscopy -- it is not based on the findings at surgery.

If surgery is done, it may show that the cancer has spread more than the doctors first thought. This new information may change the treatment plan, but it does not change the patient's stage.

Tumor extent (T)

Tis: The cancer cells are only found on the surface of the cervix (in the layer of cells lining the cervix), without growing into deeper tissues. (Tis is not included in the FIGO system)

T1: The cancer cells have grown from the surface layer of the cervix into deeper tissues of the cervix. The cancer may also be growing into the body of the uterus, but it has not grown outside of the uterus.

T1a: There is a very small amount of cancer, and it can be seen only under a microscope.

T1a1: The area of cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide.

T1a2: The area of cancer invasion is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide.

T1b: This stage includes stage I cancers that can be seen without a microscope. This stage also includes cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm.

T1b1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).

T1b2: The cancer can be seen and is larger than 4 cm.

T2: In this stage, the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina. The cancer may have grown into the upper part of the vagina.

T2a: The cancer has not spread into the tissues next to the cervix (called the parametria).

T2a1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).

T2a2: The cancer can be seen and is larger than 4 cm.

T2b: The cancer has spread into the tissues next to the cervix (the parametria)

T3: The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder).

T3a: The cancer has spread to the lower third of the vagina but not to the walls of the pelvis.

T3b: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters (this is called hydronephrosis).

T4: The cancer has spread to the bladder or rectum or it is growing out of the pelvis

Lymph node spread (N)

NX: The nearby lymph nodes cannot be assessed

N0: No spread to nearby lymph nodes

N1: The cancer has spread to nearby lymph nodes

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant organs (such as the lungs or liver), to lymph nodes in the chest or neck, and/or to the peritoneum (the tissue coating the inside of the abdomen).

Stage grouping

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers.

Stage 0 (Tis, N0, M0): The cancer cells are only in the cells on the surface of the cervix (the layer of cells lining the cervix), without growing into (invading) deeper tissues of the cervix. This stage is also called carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III (CIN III). This stage is not included in the FIGO system.

Stage I (T1, N0, M0): In this stage the cancer has grown into (invaded) the cervix, but it is not growing outside the uterus. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IA (T1a, N0, M0): This is the earliest form of stage I. There is a very small amount of cancer, and it can be seen only under a microscope. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IA1 (T1a1, N0, M0): The cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IA2 (T1a2, N0, M0): The cancer is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IB (T1b, N0, M0): This stage includes stage I cancers that can be seen without a microscope as well as cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm. These cancers have not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IB1 (T1b1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IB2 (T1b2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): In this stage, the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina.

Stage IIA (T2a, N0, M0): The cancer has not spread into the tissues next to the cervix (called the parametria). The cancer may have grown into the upper part of the vagina. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IIA1 (T2a1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IIA2 (T2a2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIB (T2b, N0, M0): The cancer has spread into the tissues next to the cervix (the parametria). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage III (T3, N0, M0): The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIIA (T3a, N0, M0): The cancer has spread to the lower third of the vagina but not to the walls of the pelvis. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIIB (T3b, N0, M0; OR T1-3, N1, M0): either:

• The cancer has grown into the walls of the pelvis and/or has blocked one or both ureters (a condition called hydronephrosis), but has not spread to lymph nodes or distant sites.

OR

• The cancer has spread to lymph nodes in the pelvis (N1) but not to distant sites (M0). The tumor can be any size and may have spread to the lower part of the vagina or walls of the pelvis (T1-T3).

Stage IV: This is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.

Stage IVA (T4, N0, M0): The cancer has spread to the bladder or rectum, which are organs close to the cervix (T4). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver.

Survival rates by stage

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about the survival statistics below for cervical cancer is up to you.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with cervical cancer.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors may affect a person's outlook, such as their general health and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.

The numbers below come from the National Cancer Data Base, and are based on people diagnosed between 2000 and 2002.

Last Medical Review: 09/14/2009
Last Revised: 01/19/2010