Cervical cancer (staging)

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

Classification

Revised FIGO staging of cervical carcinoma (2018)

• FIGO no longer includes stage 0 (Tis)
• I: confined to cervix uteri (extension to the corpus should be disregarded)
  • IA: invasive carcinoma only diagnosed by microscopy
    • IA1: stromal invasion <3 mm in depth
    • IA2: stromal invasion ≥3 mm and <5 mm in depth
  • IB: invasive invasive carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion limited to the cervix uteri
    • IB1: invasive invasive carcinoma ≥5 mm depth of stromal invasion and <2 cm in greatest dimension
    • IB2: invasive carcinoma ≥2 cm and <4 cm in greatest dimension
    • IB3: invasive carcinoma ≥4 cm in greatest dimension
• II: beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall
  • IIA: involvement limited to the upper 2/3 of vagina without parametrial invasion
    • IIA1: invasive carcinoma <4 cm in greatest dimension
    • IIA2: invasive carcinoma ≥4 cm in greatest dimension
  • IIB: with parametrial involvement but not up to the pelvic wall
• III:carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non‐functioning kidney and/or involves pelvic and/or paraaortic lymph nodes
  • IIIA: carcinoma carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
  • IIIB: extension extension to the pelvic wall and/or hydronephrosis or non‐functioning kidney (unless known to be due to another cause)
  • IIIC: involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumour size and extent
    • IIIC1: pelvic lymph node metastasis only
    • IIIC2: para-aortic lymph node metastasis
    • with r (imaging) and and p (pathology) notations to indicate how lymph nodes were identified
• IV: carcinoma has extended beyond the true pelvis or has involved (biopsy-proven) the mucosa of the bladder or rectum (bullous oedema, as such, does not permit a case to be allotted to stage IV)
  • IVA: spread to adjacent organs
  • IVB: spread to distant organs ⁸

TNM Staging 2021 (AJCC version 9)

Primary tumour (T)

• Tx: primary tumour cannot be assessed
• T0: no evidence of primary tumour
• Tis: carcinoma in situ (cis)
• T1: cervical carcinoma confined to the uterus (extension to the corpus should be disregarded)
  • T1a: invasive carcinoma diagnosed only by microscopy (depth of invasion < 5 mm)¹¹
  • 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: tumour without parametrial invasion
  • T2b: tumour with parametrial invasion
• T3: tumour extends to pelvic wall and/or involves lower third of vagina, and/or causes hydronephrosis
  • T3a: tumour involves lower third of vagina, no extension to pelvic wall
  • T3b: tumour extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
• T4: tumour invades the mucosa of bladder or rectum, and/or extends beyond true pelvis ¹¹

Regional lymph nodes (N)

• Nx: regional lymph nodes cannot be assessed
• N0: no regional lymph nodes metastasis
• N1: regional lymph node metastases to pelvic lymph nodes only
• N2: regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes ¹¹

Distant metastasis (M)

• M0: no distant metastasis
• M1: distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease, lung, liver, or bone; excludes metastasis to pelvic or para-aortic lymph nodes or vagina)¹¹

See also

• endometrial cancer staging
• vaginal cancer staging
• vulval cancer staging
• ovarian cancer staging
• FIGO staging system