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Cancer Staging Systems
Staging of cervical cancer
Last Update: Sunday January 4th, 2004 7:15 PM GMT
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: 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 maximal
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 more than 3 mm
and not more than 5 mm with a horizontal spread 7 mm or less
- T1b/IB: Clinically visible lesion confined to the
cervix or microscopic lesion greater than T1a2/IA2
- T1b1/IB1: Clinically visible lesion 4 cm or less
in greatest dimension
- T1b2/IB2: Clinically visible lesion more than 4 cm
in greatest dimension
- T2/II: Cervical carcinoma invades beyond uterus but
not to 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 lower third of the
vagina, no extension to pelvic wall
- T3b/IIIB: Tumor extends to pelvic wall and/or
causes hydronephrosis or nonfunctioning kidney
- T4/IVA: Tumor invades mucosa of the bladder or
rectum, and/or extends beyond true pelvis (bullous edema is not
sufficient to classify a tumor as T4)
- M1/IVB: Distant metastasis
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: Distant metastasis
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Stage 0 is carcinoma in situ, intraepithelial carcinoma. There is
no stromal invasion.
- T2b, N0, M0
- T1, N1, M0
- T2, N1, M0
- T3a, N1, M0
- T3b, any N, M0
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 not be more than 5 mm 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 no
greater than 3 mm in depth and no wider than 7 mm diameter.
- Stage IA2: Measured invasion of stroma greater
than 3 mm but no greater than 5 mm in depth and no wider than 7 mm
- Stage IB: Clinical lesions confined to the cervix or
preclinical lesions greater than stage IA.
- Stage IB1: Clinical lesions no greater than 4 cm
- Stage IB2: Clinical lesions greater than 4 cm in
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.
- Stage IIA: No obvious parametrial involvement.
Involvement of up to the upper two thirds of the vagina.
- Stage IIB: Obvious parametrial involvement, but not
onto the pelvic sidewall.
Stage III is carcinoma that has extended onto the pelvic sidewall.
On rectal examination, there is no cancer-free space between the tumor
and the pelvic sidewall. The tumor involves the lower third of the
vagina. 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 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
- Stage IVB: Spread to distant organs.
- Shepherd JH: Cervical and vulva cancer: changes in FIGO
definitions of staging. Br J Obstet Gynaecol 103 (5): 405-6, 1996.
- Creasman WT: New gynecologic cancer staging. Gynecol Oncol 58
(2): 157-8, 1995.
- Cervix uteri. In: American Joint Committee on Cancer.: AJCC
Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven
Publishers, 1997, pp 189-194.