Cervical cancer (staging)
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 tumour <4 cm in greatest dimension
- Ib2: clinically visible tumour >4 cm in greatest dimension
- stage Ia: invasive carcinoma only diagnosed by microscopy.
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 tumour <4 cm in greatest dimension
- stage IIa2: clinically visible tumour >4 cm in greatest dimension
- stage IIb: with parametrial invasion
- stage IIa: involves upper 2/3rd of vagina without parametrial invasion
- stage IIIa: tumour 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 tumour 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.
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).
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- 2. Pannu HK, Corl FM, Fishman EK. CT evaluation of cervical cancer: spectrum of disease. Radiographics. 21 (5): 1155-68. Radiographics (full text) [pubmed citation]
- 3. Sala E, Wakely S, Senior E et-al. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol. 2007;188 (6): 1577-87. doi:10.2214/AJR.06.1196 - Pubmed citation
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- 5. Okamoto Y, Tanaka YO, Nishida M et-al. MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics. 23 (2): 425-45. doi:10.1148/rg.232025065 - Pubmed citation
- 6. Kaur H, Silverman PM, Iyer RB et-al. Diagnosis, staging, and surveillance of cervical carcinoma. AJR Am J Roentgenol. 2003;180 (6): 1621-31. AJR Am J Roentgenol (full text) - Pubmed citation
- 7. Olivetti L, Grazioli L. Imaging of Urogenital Diseases, A Color Atlas. Springer Verlag. (2009) ISBN:8847013437. Read it at Google Books - Find it at Amazon
- 8. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105 (2): 103-4. - Pubmed citation
- 9. Government of Western Australia: Staging of cervical cancer Diagnostic imaging pathway
- 10. American Joint Committee on Cancer - Cervix Uteri Cancer Staging