Cervical cancer stages

Making an educated treatment decision begins with knowing the stage, or progression, of the disease. The stage of cervical cancer is one of the most important factors in evaluating treatment options.

At Cancer Treatment Centers of America® (CTCA), our doctors use a variety of diagnostic tests to evaluate cervical cancer and develop an individualized treatment plan. If you’ve been recently diagnosed, we will review your pathology to confirm you’ve received the correct diagnosis and staging information. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

Diagnostic tests to determine cancer stage

To determine the stage, doctors may use the following tests, or a combination of these procedures:

• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) scan
• Ultrasound exam
• Chest X-ray

Your care team may also need to perform a procedure to collect more information about the cancer. These may include:

• Biopsy of the original tumor
• Lymph node biopsy
• Cystoscopy
• Laparoscopy
• Pre-treatment surgical staging

FIGO system for staging

Cervical cancer is staged using the International Federation of Gynecology and Obstetrics, or FIGO, system. Within the four main stages, there are substages to account for different features of cervical cancer.

Three main factors are used to determine cervical cancer staging:

• How far the cancer has spread within the cervix
• If it’s spread to nearby areas or lymph nodes 
• If it’s reached lymph nodes or other organs

Cervical cancer stages

Stage 1: The cancer is limited to the cervix and hasn’t grown any farther. This stage is further separated into subcategories.

• Stage 1A: The cancer is still so small that only a microscope can see it.
  • Stage 1A1: There is a tiny amount of cancer. The tumor has grown 3 mm or less into the tissue of the cervix.
  • Stage 1A2: The tumor has grown 3 to 5 mm into the tissue of the cervix.
• Stage 1B: Though bigger than a stage 1A tumor, the cancer remains contained in the cervical tissue.
  • Stage 1B1: The tumor is 2 cm or less in size and has grown 5 mm or more into the cervix's tissue.
  • Stage 1B2: The tumor measures between 2 and 4 cm. Stage 1B3: The tumor is at least 4 cm.

Stage 2: The cancer has spread to the upper part of the vagina or the tissue surrounding the uterus, but it hasn’t spread to lymph nodes or distant sites.

• Stage 2A: The cancer has spread to the upper part of the vagina but hasn’t reached the tissue surrounding the uterus.
  • Stage 2A1: The tumor measures 4 cm or smaller in size.
  • Stage 2A2: The tumor measures 4 cm or larger in size.
• Stage 2B: The cancer has spread to the tissue surrounding the uterus.

Stage 3: The cancer has reached the lower portion of the vagina and/or the muscles that surround the pelvic area (pelvic walls). The tumor may be large enough to cause kidney problems by blocking the tubes that transport urine from the kidneys to the bladder (the ureters). It may have reached nearby lymph nodes.

• Stage 3A: The cancer has entered the lower portion of the vagina, but it hasn’t reached the pelvic walls.
• Stage 3B: The cancer has reached the pelvic walls and/or it’s causing kidney problems by blocking one or both ureters.
• Stage 3C: The cancer has grown into lymph nodes.
  • Stage 3C1: The cancer has grown into lymph nodes in the pelvis.
  • Stage 3C2: The cancer has reached lymph nodes around the aorta.

Stage 4: The cancer has spread into the bladder, rectum, or beyond the pelvic area to distant parts of the body.

• Stage 4A: The cancer has grown into nearby organs such as the bladder or rectum, or is spreading out of the pelvic area.
• Stage 4B: The cancer has spread to organs such as the liver, lungs, bones or distant lymph nodes.

Recurrent cervical cancer

Recurrent cervical cancer occurs when the cancer is detected months or years after the completion of an initial cancer treatment regimen, which may have included surgery, radiation therapy and/or chemotherapy. It may be a local recurrence, which is contained to the cervical region. A metastatic recurrence occurs when the cancer has spread to other organs, such as the kidney, bladder or lymph nodes. This recurrence happens when the cervical cancer cells break off from the original tumor and travel to other parts of the body through the lymphatic or circulatory system. The cells then reattach at a new location. When the disease appears in another part of the body, it may be referred to as regional or distant recurrence. Symptoms of recurrent cervical cancer vary from patient to patient.

Signs and symptoms of local cervical cancer recurrence may include:

• Bleeding between periods, after sexual intercourse or after menopause
• Periods that are heavier and last longer than usual
• Unusual vaginal discharge that may be watery, pink or foul-smelling
• Pelvic pain or pain during intercourse
• Leakage of urine from the vagina

Signs and symptoms of distant cervical cancer recurrence may include:

• Weight loss
• Fatigue
• Back pain
• Leg pain or swelling
• Bone pain that persists

Follow-up appointments with your cancer care team may help detect cervical cancer relapse early. Your doctor may ask you about symptoms or problems that you may be experiencing. The doctor may perform a pelvic examination and a Pap smear. Additional lab and/or imaging tests may also be recommended.

A number of treatment options are available for cancer that has relapsed, especially when it’s detected early. About 35 percent of patients with invasive cervical cancer develop persistent or recurrent disease following treatment. The recurrent cervical cancer rate is lower for those with early-stage disease. Most cancer recurrences occur within two years of treatment.