Cervical cancer (staging)

Last revised by Henry Knipe on 04 Jul 2022

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 carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion limited to the cervix uteri
      • IB1: 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 involves the lower third of the vagina, with no extension to the pelvic wall
    • IIIB: 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 tumor size and extent
      • IIIC1: pelvic lymph node metastasis only
      • IIIC2: para-aortic lymph node metastasis
      • with r (imaging) 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 edema, 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 tumor (T)
  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • 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: 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 or nonfunctioning kidney (unless known to be due to another cause)
  • T4: tumor 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

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Cases and figures

  • Figure 1: cervical cancer and Brenner tumor (gross pathology)
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  • Case 1: stage IV
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  • Case 2: stage IVa
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  • Case 3
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  • Case 4: stage T2BN1M0
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  • Case 5: stage IVa
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  • Case 6: stage IVa
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