Stages of Cervical Cancer 

The staging system for cervical cancer is based on clinical criteria.

Stage I disease is limited to the cervix.

Stage II disease extends beyond the cervix to the upper two-thirds of the vagina (IIA) or the parametrial tissue (IIB) but not to the pelvic sidewall.

Stage III tumors spread to the lowest third of the vagina (IIIA) or pelvic side wall (IIIB).

And stage IV tumors invade the mucosa of the bladder or rectum (IVA) or spread to distant sites (IVB).

The use of noninvasive radiographic imaging for cervical cancer staging is also controversial. The FIGO system limits the imaging methodology to chest x-ray, IVP, and barium enema. Since the staging of carcinoma of the cervix remains largely a clinical evaluation, the use of magnetic resonance imaging (MRI) and/or computed tomography (CT) scans may aid in treatment planning  but is not accepted for staging purposes.

The FIGO has always maintained that staging is intended for worldwide comparison purposes alone and not as a guide for therapy.

Currently, the FIGO surgical procedures for staging are limited to colposcopy, biopsy, conization of the cervix, cystoscopy, and proctosigmoidoscopy. Laparoscopy, hysteroscopy, and retroperitoneal exploration are not accepted.

Although the FIGO staging system divides patients into groups with differing mean five-year survival rates (IA 100%; IB 85%; IIA 80%; IIB 45%; IVA 15%), it has been criticized because it has not considered important prognostic variables such as tumor size and lymph node involvement that could be applied to predict a wide range of prognoses within and broad overlap between stage groups.

For stage 0 to IB1, the treatment may include surgery, radiation therapy, or both depending on patient and physician preference. For stage IB2 and above, the primary treatment consists of concurrent chemoradiation with platinum-based chemotherapy.

Data from five phase III randomized trials, which together involve 1,912 patients with cervical cancer demonstrated that platinum-based chemotherapy given concurrently with radiation therapy prolongs survival in women with locally advanced cervical cancer, stages IB-IVA.

Additionally, response rates and survival were improved in women with stage I-IIA disease who were found to have metastatic disease in the pelvic lymph nodes, positive parametrial disease, or positive surgical margins at the time of primary surgery. Concurrent radiotherapy and cisplatin-based chemotherapy reduced the risk of recurrence by 30-50% across a spectrum of chemotherapy prescriptions.

Neoadjuvant chemotherapy prior to surgery or radiation therapy is another treatment modality under investigation. An advantage of chemotherapy in this setting is the potential significant reduction in localized disease, which facilitates surgical excision, for example, in women with Stage IB2 lesions.

Theoretically, the combination of chemotherapy and surgery may obviate the need for radiation therapy, and may be useful in regions where radiotherapy facilities are limited. A potential disadvantage, however, is the induction of added resistance to radiation therapy induced by chemotherapy, which may increase the likelihood of local failure in patients with positive surgical margins and/or pelvic lymph node involvement.

Last updated Nov 26/06