If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread to lymph nodes, and if it’s spread to other parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.
Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may have some lymph nodes removed for testing. To learn more about the extent of the disease, the gynecologic oncologist may order some of the following tests:
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Chest X-rays
X-rays often can show whether cancer has spread to the lungs.
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CT Scan
An x-ray machine linked to a computer takes a series of detailed pictures of your organs. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. You may receive contrast material by injection in your arm or hand, mouth, or enema. The contrast material makes abnormal areas easier to see.
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MRI
A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly in the picture.
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PET scan
You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter in the pictures.
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Biomarker Testing of the Tumor
Your doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Because cervical cancer is nearly always caused by the human papillomavirus (HPV), additional tests may be run to see if there are specific mutations related to the specific type of HPV that lead to the cancer development. This can help the oncologists know which drugs may work best for treatment.
If there are signs or symptoms of bladder or rectal problems, these procedures may be recommended and may be performed at the same time as a pelvic examination:
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Cystoscopy
A procedure that looks inside the bladder and urethra to check for abnormal areas. A cystoscope — a thin, tube-like instrument with a light and a lens for viewing — is inserted through the urethra into the bladder. This instrument may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
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Sigmoidoscopy
A procedure that uses a sigmoidoscope to look inside the rectum and sigmoid (lower) colon for abnormal areas. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples so they can be viewed under a microscope for signs of cancer.
The information gathered during this process will allow the doctor to give the cancer a stage.
Stages of Cervical Cancer
Stage I Cervical Cancer
The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix. It is divided into stages IA and IB, based on the size of the tumor and the deepest point of tumor invasion.
- Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.
Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.
Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.
- Stage IB:In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.
Stage IB1: The tumor is 5 mm or more in depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.
Stage IB2: The tumor is 5 mm or more in depth and between 2 and 4 cm wide.
Stage IB3: The tumor is 4 cm or more in width.
Stage II Cervical Cancer
The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall. This stage may be divided into smaller groups to describe the cancer in more detail.
- Stage IIA:The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.
Stage IIA1: The tumor is less than 4 cm wide.
Stage IIA2: The tumor is 4 cm or more in width.
Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.
Stage III Cervical Cancer
The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall and/or involves regional lymph nodes. If the tumor blocks the flow of urine, one or both kidneys may not be working well.
Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.
Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.
- Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase "r" indicates imaging tests were used to confirm lymph node involvement. A lowercase "p" indicates pathology results were used to determine the stage.
Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.
Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.
Stage IVA Cervical Cancer
The tumor invades the bladder or rectum, but it has not spread to other parts of the body.
Stage IVB Cervical Cancer
The cancer has spread to other parts of the body.
Recurrent Cervical Cancer
The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.
Find a Gynecologic Cancer Specialist Near You
The comprehensive approach offered by our gynecologic cancer team at Affiliated Oncologists combines the most advanced treatments with education and support services. Our oncologists specialize in women’s cancers and are ready to talk to you about your diagnosis and personalized cervical cancer treatment options.
Our gynecologic cancer centers are located throughout the South Chicago suburbs, including Downers Grove and Oak Lawn, IL.