Cervical Cancer: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has spread to nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The place where cancer starts is called the primary site. Cervical cancer can spread from the primary site to other parts of your body. Cancer that has spread is called metastatic cancer. When a cancer spreads, it’s said to have metastasized.

How does cervical cancer spread?

Cervical cancer starts on the surface lining of the cervix. As cervical cancer grows, it can grow into the deeper layers of the cevix. Then, like all cancers, it can spread (metastasize) to other parts of the body.

Cervical cancer can start growing in other parts of the body and spread in two main ways: 

• It may grow larger and grow into nearby organs, such as the vagina, bladder, rectum, or other tissues near the uterus and vagina.

• It may spread through the lymph nodes in the pelvis.

A third type of spread is through the bloodstream. This is not as common with cervical cancer.

When cervical cancer has spread to another part of the body, it's not a new cancer. For example, if it spreads to the vagina, it's not called vaginal cancer. It's still cervical cancer. This is because cancer is named for the site of the original or primary tumor. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The systems of staging

Healthcare providers use different systems to stage cancer. There are two systems used most often to stage cervical cancer:

• FIGO staging system

• TNM staging system

The two systems are much the same. They both use the TNM system. Here's what the letters stand for:

• T tells how far the main tumor has spread into the cervix and nearby tissue.

• N tells if the lymph nodes in the area of the original tumor have cancer in them.

• M tells if the cancer has spread (metastasized) to distant organs in the body, such as the liver, lungs, bones, or lymph nodes in another part of the body.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

• X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of lymph node spread (N0).

What are the stage groupings of cervical cancer?

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer.

A stage grouping is listed as a Roman numeral and can have a value of I through IV (1 through 4). The higher the number, the more advanced your cancer is.

 

These are the stage groupings of cervical cancer and what they mean:

Stage I. This cancer has grown into the deeper tissues of the cervix. It may be growing into the uterus, but hasn't grown outside the uterus. It may or may not be in nearby lymph nodes. It has not spread to distant parts of your body. Stage I is then divided into these groups:

• Stage IA. The provider can’t see this cancer without a microscope.

• Stage IA1. It The cancer is less than 3 millimeters (mm) deep and less than 7 mm wide.

• Stage IA2. The cancer is between 3 and 5 mm deep but still less than 7 mm wide.

• Stage IB. The tumor may be seen without a microscope. Or it can only be seen with a microscope and is more than 5 mm deep or more than 7 mm wide.

• Stage IB1. The tumor can be seen without a microscope and is less than 4 centimeters (cm) in size.

• Stage IB2. A provider can see this cancer without a microscope. It is larger than 4 cm in size.

Stage II. This cancer has spread beyond the cervix and uterus, but has not spread to the walls of the pelvis or to the lower part of the vagina. It may or may not be in nearby lymph nodes. It has not spread to distant parts of the body. Stage II is then divided into these groups:

• Stage IIA. This cancer has not spread to the tissues next to the cervix called the parametria.

• Stage IIA1. The cancer can be seen with the naked eye and is 4 cm or less in size.

• Stage IIA2. The cancer can be seen with the naked eye and is more than 4 cm in size.

• Stage IIB. This cancer has spread to the tissues next to the vagina and cervix (called the parametria).

Stage III. This cancer may or may not be in nearby lymph nodes. It has not spread to distant parts of the body. Stage III is then divided into these groups:

• Stage IIIA. The cancer has spread to the lower part of the vagina or to the wall of the pelvis. It may be causing kidney problems by blocking urine flow to the bladder (hydronephrosis).

• Stage IIIB. The cancer has spread to the wall of the pelvis and/or is blocking urine flow tothe bladder (hydronephrosis) from one or both kidneys. 

Stage IV. Stage IV is divided into these groups:

• Stage IVA. The cancer has spread to the bladder or rectum, or it's growing outside the pelvis. It may or may not have spread to nearby lymph nodes. It has not spread to distant parts of the body.

• Stage IVB. The cancer has spread to distant organs beyond the pelvis, such as the liver, lungs, bones, or distant lymph nodes.

 

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.