Cervical cancer (staging)

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 tumour <4 cm in greatest dimension
      • Ib2: clinically visible tumour >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 tumour <4 cm in greatest dimension
      • stage IIa2: clinically visible tumour >4 cm in greatest dimension
    • stage IIb: with parametrial invasion
  • stage III
    • 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.

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).


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Article information

rID: 1091
Section: Staging
Tag: 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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