Stage Information
TNM Definitions
AJCC Stage Groupings
FIGO Staging
Cervical carcinoma has its origins at the squamous-columnar junction whether in
the endocervical canal or on the portio of the cervix. The precursor lesion is
dysplasia or carcinoma in situ (cervical intraepithelial neoplasia [CIN]),
which can subsequently become invasive cancer. This process can be quite slow.
Longitudinal studies have shown that in untreated patients with in situ
cervical cancer, 30% to 70% will develop invasive carcinoma over a period of 10
to 12 years. However, in about 10% of patients, lesions can progress from in
situ to invasive in a period of less than 1 year. As it becomes invasive, the
tumor breaks through the basement membrane and invades the cervical stroma.
Extension of the tumor in the cervix may ultimately manifest as ulceration,
exophytic tumor, or extensive infiltration of underlying tissue including
bladder or rectum.
In addition to local invasion, carcinoma of the cervix can spread via the
regional lymphatics or bloodstream. Tumor dissemination is generally a
function of the extent and invasiveness of the local lesion. While cancer of
the cervix generally progresses in an orderly manner, occasionally a small
tumor with distant metastasis is seen. For this reason, patients must be
carefully evaluated for metastatic disease.
Stages are defined by the Federation Internationale de Gynecologie et
d’Obstetrique (FIGO) or the American Joint Committee on Cancer’s (AJCC) TNM
classification.[1-3]
TNM Definitions
The definitions of the T categories correspond to the several stages accepted
by FIGO.
TNM Categories/FIGO Stages
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis/0: Carcinoma in situ
- T1/I: Cervical carcinoma confined to uterus (extension to corpus should be
disregarded)
- T1a/IA: Invasive carcinoma diagnosed only by microscopy. All
macroscopically visible lesions—even with superficial invasion—are T1b/IB. Stromal invasion with a maximum depth of 5
mm measured from the base of the epithelium and a horizontal spread of 7 mm or less. Vascular space involvement, venous or lymphatic,
does not affect classification
- T1a1/Ia1: Measured stromal invasion 3 mm or less in depth and 7 mm or less in horizontal spread
- T1a2/IA2: Measured stromal invasion 3 mm or more and 5 mm
or less with a horizontal spread of 7 mm
or less
- T1b/IB: Clinically visible lesion confined to the cervix or microscopic
lesion larger than T1a/IA2
- T1b1/IB1: Clinically visible lesion 4 cm or smaller in greatest dimension
- T1b2/IB2: Clinically visible lesion 4 cm or larger in dimension
- T2/II: Cervical carcinoma invades beyond the uterus but not to the pelvic wall or
to the lower third of the vagina
- T2a/IIA: Tumor without parametrial involvement
- T2b/IIB: Tumor with parametrial involvement
- T3/III: Tumor extends to the pelvic wall, and/or involves the lower third
of the vagina, and/or causes hydronephrosis or nonfunctioning kidney
- T3a/IIIA: Tumor involves the lower third of the vagina and does not extend to the pelvic
wall
- T3b/IIIB: Tumor extends to the pelvic wall and/or causes hydronephrosis or
nonfunctioning kidney
- T4/IVA: Tumor invades mucosa of the bladder or rectum and/or extends
beyond the true pelvis (bullous edema is not sufficient to classify a tumor as T4)
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1/IVB: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage 0 is carcinoma in situ or intraepithelial carcinoma. There is no stromal
invasion.
Stage I
Stage IA
Stage IA1
Stage IA2
Stage IB
Stage IB1
Stage IB2
Stage II
Stage IIA
Stage IIB
- T2b, N0, M0
Stage III
Stage IIIA
Stage IIIB
- T1, N1, M0
- T2, N1, M0
- T3a, N1, M0
- T3b, any N, M0
Stage IVA
Stage IVB
FIGO Staging
Stage I
Stage I is carcinoma strictly confined to the cervix; extension to the uterine
corpus should be disregarded.
- Stage IA: Invasive cancer identified only microscopically. All gross
lesions even with superficial invasion are stage IB cancers.
Invasion is limited to measured stromal invasion with a maximum
depth of 5 mm* and no wider than 7 mm. [Note: *The depth of invasion should be 5 mm or less taken from the base of the
epithelium, either surface or glandular, from which it originates. Vascular
space involvement, either venous or lymphatic, should not alter the staging.]
- Stage IA1: Measured invasion of the stroma 3 mm or less in
depth and 7 mm or less in diameter.
- Stage IA2: Measured invasion of stroma more than 3 mm but 5 mm or less in depth and 7 mm or less in diameter.
- Stage IB: Clinical lesions confined to the cervix or preclinical lesions
greater than stage IA.
- Stage IB1: Clinical lesions 4 cm or less in size.
- Stage IB2: Clinical lesions 4 cm or more in size.
Stage II
Stage II is carcinoma that extends beyond the cervix but has not extended onto
the pelvic wall. The carcinoma involves the vagina but not as far as the
lower third section.
- Stage IIA: No obvious parametrial involvement. Involvement of as much as the upper two thirds of the vagina.
- Stage IIB: Obvious parametrial involvement but not onto the pelvic sidewall.
Stage III
Stage III is carcinoma that has extended onto the pelvic sidewall and/or involves the lower third of the vagina. On rectal
examination, there is no cancer-free space between the tumor and the pelvic
sidewall. All cases with a
hydronephrosis or nonfunctioning kidney should be included, unless they are
known to be due to other causes.
- Stage IIIA: No extension onto the pelvic sidewall but involvement of the
lower third of the vagina.
- Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or
nonfunctioning kidney.
Stage IV
Stage IV is carcinoma that has extended beyond the true pelvis or has
clinically involved the mucosa of the bladder and/or rectum.
- Stage IVA: Spread of the tumor onto adjacent pelvic organs.
- Stage IVB: Spread to distant organs.
References
-
Shepherd JH: Cervical and vulva cancer: changes in FIGO definitions of staging. Br J Obstet Gynaecol 103 (5): 405-6, 1996.
[PUBMED Abstract]
-
Creasman WT: New gynecologic cancer staging. Gynecol Oncol 58 (2): 157-8, 1995.
[PUBMED Abstract]
-
Cervix uteri. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 259-65.
Back to Top
< Previous Section | Next Section > |