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. Cervical cancer is staged with the FIGO (International Federation of Gynecology and Obstetrics) System of Staging. 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 FIGO stage. This staging system is different from those for other cancers. The systems for other cancers take into account whether the cancer has spread to local lymph nodes. The FIGO doesn't, even though we know the outlook worsens if the cancer has spread to lymph nodes.

Stage 0: 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).

Stage I: In this stage the cancer has grown into (invaded) the cervix, but it has not spread anywhere else.

Stage IA: 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.

• Stage IA1: The area of cancer invasion is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide.

• Stage IA2: 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.

Stage IB: 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.

• Stage IB1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).

• Stage IB2: The cancer can be seen and is larger than 4 cm.

Stage II: 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: 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.

• Stage IIB: The cancer has spread into the tissues next to the cervix (the parametria).

Stage III: 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).

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

• Stage IIIB: The cancer has grown into the walls of the pelvis. If the tumor has blocked the ureters (a condition called hydronephrosis) it is also a stage IIIB.

Note: In the alternate staging system by the American Joint Committee on Cancer, in stage IIIB is defined by the fact that the cancer has spread to lymph nodes in the pelvis.

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: The cancer has spread to the bladder or rectum, which are organs close to the cervix.

• Stage IVB: The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver.

Survival rates by stage

These statistics come from the National Cancer Institute's SEER program. These numbers come from women diagnosed between 1988 and 2001. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Five-year rates are used to produce a standard way of discussing prognosis. Of course, many people live much longer than 5 years. Five-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to describe the outlook for patients with a particular type and stage of cancer

Last Medical Review: 09/14/2009
Last Revised: 10/28/2009