Cervical cancer (staging)

Dr Craig Hacking and A.Prof Frank Gaillard et al.

Staging of cervical cancer can either be based on the TNM or FIGO system.

Revised FIGO staging of cervical carcinoma 2009 8
  • stage 0: cervical intraepithelial neoplasia (HSIL or CIN III) 
  • stage I: confined to cervix
    • stage Ia: invasive carcinoma only diagnosed by microscopy.
      • Ia1: stromal invasion <3 mm in depth and <7 mm in extension (microinvasive)
      • Ia2: stromal invasion  >3 mm depth and not >5 mm and extension <7 mm
    • stage Ib: clinically visible lesions limited to the cervix or pre-clinical cancers >stage 1a
      • Ib1: clinically visible tumor <4 cm in greatest dimension
      • Ib2: clinically visible tumor >4 cm in greatest dimension
  • stage II: beyond cervix though not to the pelvic sidewall or lower third of the vagina.
    • stage IIa: involves upper 2/3rd of vagina without parametrial invasion
      • stage IIa1: clinically visible tumor <4 cm in greatest dimension
      • stage IIa2: clinically visible tumor >4 cm in greatest dimension
    • stage IIb: with parametrial invasion
  • stage III
    • stage IIIa: tumor involves the lower third of the vagina with no extension to pelvic sidewall
    • stage IIIb: extension to pelvic side wall or causing obstructive uropathy, MR imaging findings that are suggestive of pelvic sidewall involvement include tumor within 3 mm of or abutment of the internal obturator, levator ani, and pyriform muscles and the iliac vessel 6
  • stage IV: extension beyond true pelvis or biopsy proven to involve the mucosa of the bladder or the rectum
    • stage IVa: extension beyond true pelvis or rectal/bladder invasion
    • stage IVb: distant organ spread 

For an imaging pathway on the best modalities in accurate staging of cervical cancer: see reference 9.

TMN Staging10
Primary Tumor (T)
  • Tx: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Cervical carcinoma confined to the uterus
    • T1a: Invasive carcinoma diagnosed only by microscopy
    • T1b: Clinically visible lesion confined to the cervix
  • T2: Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina
    • T2A: Tumor without parametrial invasion
    • T2B: Tumor with parametrial invasion
  • T3: Tumor extends to pelvic wall and/or involves lower third of vagina, and/or causes hydronephrosis
    • T3a: Tumor involves lower third of vagina, no extension to pelvic wall
    • T3b: Tumor extends to pelvic wall and/or causes hydronephrosis
  • T4: Tumor invades bladder or rectum, and/or extends beyond true pelvis
Regional Lymph nodes (N)

Nx: Regional lymph nodes cannot be assessed.

No: No regional lymph nodes metastatsis

N1: Regional lymph node metastases

Distant Metastasis (M)

M0: No distant mets

M1: Distant mets (including peritoneal spread, involvement of supraclavicular, mediastinal or para-aortic lymph nodes, lung, liver or bone).

See also

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Article information

rID: 1091
Section: Staging
Tag: cases, cases
Synonyms or Alternate Spellings:
  • Cervical carcinoma staging
  • Staging of cervical carcinoma
  • Staging of cervical cancer
  • Staging of carcinoma of the cervix
  • Staging of carcinoma of cervix

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Cases and figures

  • Case 1: stage IV
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  • Case 2: stage IVa
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