Cervical Cancer Stages
After a physician confirms a diagnosis of cervical cancer, the next step is to evaluate the extent and spread of the tumor. Known as staging, this process involves performing various examinations and tests to determine the size of the tumor, how deeply it has invaded the tissues in and around the cervix and whether it has spread to distant areas of the body (metastasized). As such, cervical cancer staging provides important information about the tumor that will influence treatment decisions.
How is cervical cancer staged?
To learn more about a cervical tumor and determine its clinical stage, a physician will typically evaluate the results of several exams, tests and procedures, such as:
- Computerized tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- Ultrasound scans
- Positron emission tomography (PET) scans
- A cervical biopsy of the tumor
- An examination of the inner bladder and urethra (cystoscopy)
- Minimally invasive surgery to obtain biopsy samples (laparoscopy)
The FIGO staging system
The International Federation of Gynecology and Obstetrics (FIGO) staging system is frequently used for staging cancers of the female reproductive system, including cervical cancer. Under the FIGO system, the stages of cervical cancer range from 1 to 4, although stage 0 may be used to refer to abnormal cells that have not grown past the surface layer of the cervix. Stages 1 through 4 are further broken down into categories signified by letters (for instance, stage 1A or 1B). In general, the lower the number and earlier the letter, the less the cancer has spread.
Stage 0 cervical cancer
Also known as cervical dysplasia, stage 0 is assigned to a group of abnormal cells that have begun to grow on the surface layer of the cervix but have not spread to nearby tissues. Because stage 0 precancer will likely continue to grow, spread into deeper tissues and possibly become cancerous, it should be promptly treated. In most cases, the abnormal cells can be removed with laser surgery, cryotherapy or a loop electrosurgical excision procedure (LEEP) and no further treatment will be needed.
Stage 1 cervical cancer
At stage 1, the cancer is confined to the cervix. Based on the size of the tumor and its deepest point of invasion, stage 1 cervical cancer can be further classified as:
- Stage 1A1 - A small amount of cancer visible only with a microscope has invaded nearby tissues to a depth of 3 millimeters or less.
- Stage 1A2 - A small amount of cancer visible only with a microscope has invaded nearby tissues to a depth of more than 3 millimeters but less than 5 millimeters.
- Stage 1B1 - The tumor is 2 centimeters or smaller in diameter and has invaded nearby tissues to a depth of more than 5 millimeters.
- Stage 1B2 - The tumor is larger than 2 centimeters but smaller than 4 centimeters in diameter.
- Stage 1B3 - The tumor is larger than 4 centimeters in diameter.
Stage 2 cervical cancer
At stage 2, the tumor has spread beyond the cervix and uterus to the upper two-thirds of the vagina and/or the tissues surrounding the uterus but has not reached the lower third of the vagina or pelvic wall. Based on the size of the tumor and how far it has spread, stage 2 cervical cancer can be further classified as:
- Stage 2A1 - The tumor is 4 centimeters or smaller in diameter and has spread to the upper two-thirds of the vagina.
- Stage 2A2 - The tumor is larger than 4 centimeters in diameter and has spread to the upper two-thirds of the vagina.
- Stage 2B - The tumor has spread to the tissues surrounding the uterus.
Stage 3 cervical cancer
At stage 3, the tumor has spread to the lower third of the vagina, the pelvic wall and/or nearby lymph nodes. Due to its critical location, the cancer may also cause kidney swelling (hydronephrosis), interfere with kidney function or block one or both ureters, which are thin tubes that carry urine from the kidneys to the bladder. Based on how far the tumor has spread, stage 3 cervical cancer can be further classified as:
- Stage 3A - The tumor has spread to the lower third of the vagina but has not reached the pelvic wall.
- Stage 3B - The tumor has spread to the pelvic wall, caused hydronephrosis and/or blocked one or both ureters.
- Stage 3C1 - The tumor has spread to lymph nodes in the pelvis.
- Stage 3C2 - The tumor has spread to lymph nodes near the aorta.
Stage 4 cervical cancer
At stage 4, the tumor has spread to the lining of the bladder or rectum and/or has reached other parts of the body, such as the lungs, liver, bones or distant lymph nodes. Based on how far the tumor has spread, stage 4 cervical cancer can be further classified as:
- Stage 4A - The tumor has spread to nearby pelvic organs, such as the bladder or rectum.
- Stage 4B - The tumor has spread beyond the pelvis to distant areas of the body.
The SEER staging system
The Surveillance, Epidemiology and End Results (SEER) staging system is often used to track cervical cancer survival rates. SEER staging typically uses the TNM (Tumor, Nodes, Metastasis) system to describe the cancer, with “T” indicating tumor size, “N” indicating lymph node involvement and “M” indicating metastasis. The SEER system provides valuable information for cancer research, epidemiological studies and treatment guidance, offering a common language for describing cancer stages and facilitating the exchange of information among scientists and clinicians.
The SEER staging system consists of three stages, which are determined based on how far the tumor has spread:
- Localized – The tumor has not spread beyond the cervix and uterus.
- Regional – The tumor has spread beyond the cervix and uterus to nearby lymph nodes.
- Distant –The tumor has spread to nearby organs or distant parts of the body.
The American Cancer Society uses the SEER database maintained by the National Cancer Institute to provide survival rate statistics for cervical cancer patients at each SEER stage. These rates are based on averages and do not consider specific data, such as the patient’s age, type of cervical cancer or overall health condition. On average, Moffitt's cervical cancer treatment survival rates exceed 1.5 times the national average.
How does cervical cancer spread?
Staging cervical cancer for treatment purposes is based on whether and how far the tumor has spread. A tumor spreads when it grows large enough to expand beyond its site of origin. In the case of cervical cancer, this can happen in any of three ways:
- Cancerous cells invade the vagina, bladder, rectum or other tissues near the uterus and vagina
- Cancerous cells spread to the lymph nodes in the pelvis
- Cancerous cells enter the bloodstream or lymphatic system, then travel to distant areas of the body
Cervical cancer tends to grow slowly, and it may take up to several years for precancerous cells on the surface of the cervix to develop into invasive cancer. This further underscores the importance of cervical cancer screening.
How treatable is cervical cancer?
When detected in an early stage, cervical cancer is highly treatable. For stage 1, the preferred approach is usually surgery to remove all or a portion of the cervix. In some cases, surgical treatment may also include removing the uterus (hysterectomy), the upper part of the vagina and/or nearby lymph nodes. In general, a patient is considered to be in remission or cured if her cervical cancer becomes undetectable and does not return for at least five years. In many cases, it never comes back.
Currently, the five-year relative survival rate for women who received treatment after being diagnosed with stage 1 cervical cancer is greater than 90%.
Moffitt Cancer Center’s approach to cervical cancer staging
At Moffitt, a patient’s cervical cancer stage is one of many factors reviewed in detail by the multispecialty team in our gynecological clinic. Each patient benefits from multiple expert opinions, which are incorporated into a highly individualized treatment plan. We are proud to provide the very latest in every aspect of cancer care, including screening, diagnostics, treatment and support. Through our robust portfolio of clinical trials, our patients can be among the first to benefit from promising new treatment options that are not yet available in other settings.
Due in part to our team’s extensive expertise and individualized approach to cancer diagnosis and treatment, Moffitt consistently achieves five-year survival rates that are higher than the national averages for patients with cervical cancer. Moreover, our most impressive survival rate statistics are for cervical cancer patients in the intermediate and advanced stages of the disease, which tend to be more challenging to treat.
After a cancer diagnosis, every day counts. Moffitt has disrupted the traditional patient care model to connect every new patient with a cancer expert as soon as possible, allowing them to start treatment right away. If you would like to learn more about our approach to diagnosing, staging and treating cervical cancer, or if you have questions about your prognosis, you can request an appointment by calling 1-888-663-3488 or submitting a new patient registration form online. You do not need a referral. Because cervical cancer staging is complex, it is best explained by a physician who is familiar with your case.
American Society of Clinical Oncology – Cervical Cancer Stages
American Cancer Society – Survival Rates for Cervical Cancer
MedicalNewsToday – Is Cervical Cancer Curable?
American Cancer Society – Treatment Options for Cervical Cancer by Stage
University of Rochester Medical Center – How Does Cervical Cancer Spread?