Cervical Cancer Staging

Cervical Cancer Staging


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How is Cervical Cancer Staged?

Staging is the process during which doctors define how far the cancer has developed. You are to be examined by your doctor and undergo diagnostic tests. On the basis of the results, he or she is able to see the size of the tumor and whether it has attacked close to the cervix tissues, lymph nodes and organs located quite far. Staging the cancer plays a very important role since the treatment will be prescribed in accordance with it.

The crux of the matter is that even if your cancer develops, the stage stays the same. If there is the case of the cancer recurrence or it starts attacking other organs, doctors refer to it using the stage that was defined when you were diagnosed with the disease. However, doctors take into account information on the current extent of the cancer. In other words, your stage stays unchanged meanwhile there is additional information that explains the current status of your disease.

Thanks to the staging system the members of the team that are responsible for your treatment can draw conclusion on the degree of the cancer’s development. If it’s about cervical cancer, there exist 2 systems that, as a rule, are used. The first one is the FIGO or International Federation of Gynecology and Obstetrics and the second one is the AJCC or American Joint Committee on Cancer. The second one is based on TNM principle of staging. Actually, both of the systems have a lot in common. Gynecologists and gynecologic oncologists take advantage of the FIGO system. However, they take into account the AJCC system as well for the staging to be 100 % accurate. AJCC system differentiates cervical cancer by considering 3 factors. They are as follows: the size of the tumor (T), whether it has invaded the lymph nodes (N) and whether it has attacked the areas located quite far (M). As for the FIGO system, the same information is taken into account. Below you’ll find a detailed description of the AJCC system that is the most up-to-date. There is also explanation of any differences between the FIGO and the AJCC given.

According to the system, there are 4 stages of the cervical cancer. The key point here is clinical findings. It implies that your doctor draws conclusion on the stage of the cancer on the basis of such tests like cystoscopy and proctoscopy that are to be carried out in some cases. Besides, he or she is to examine you thoroughly. As for the results of imaging tests or findings that occur during a surgical operation, they are not, usually, considered.

Sometimes, it so happens that after the surgical operation, the doctors find out that the disease has, actually, invaded some other areas of your organism that weren’t taken into account before. Therefore, there may be necessary alternations made to your treatment plan. Still, your stage stays unchanged.

The Extent of the Tumor You’re Dealing With (T)

If you’re staged with Tis, it means there are cancer cells located only on the lining of the cervix. The cancer hasn’t yet attacked any deeper tissues. This stage is not involved into the FIGO system.

T1 implies that there are cancer cells detected on the lining of the cervix and deeper tissues. Besides, the cancer may be invading in the uterus. However, keep in mind that it hasn’t spread outside the uterus.

T1a means that the cancer is very little and it can only be detected if studied under microscope.

  • If you’re dealing with T1a1 stage, bear in mind that the area attacked by the tumor is 3-5 mm deep (approximately 1/5 inch) and less than 7 mm wide (approximately ¼ inch).
  • If you’re dealing with T1a2 stage, bear in mind that the area attacked by the tumor is less than 3mm deep (approximately 1/8 inch) and less than 7 mm wide (approximately ¼ inch).

If you’re facing T1b stage, it implies that there is a stage 1 cancer that can be detected without using a microscope. Here it’s also about the cancers that can be detected without a microscope if they have developed less than 5 mm deep (approximately 1/5 inch) into the connective tissue. Besides, the affected area should be less than 7 mm.

  • T1b1 implies the cancer is possible to detect but it’s less than 4 cm (approximately 1 3/5 inches).
  • T1b2 implies the cancer is possible to detect and it’s bigger than 4 cm.

If you face T2 stage of the cancer, be warned that it has invaded further than the cervix and the uterus. However, the walls of the pelvis as well as the lower part of the vagina haven’t yet been invaded. At the same time, the tumor, probably, has already attacked the upper part of the vagina.

Dealing with T2a stage of the cancer implies that it has not invaded the parametria (a particular area located next to the cervix).

  • T2a1 means that the cancer is possible to detect but it’s less than 4 cm (approximately 1 3/5 inches).
  • T2a2 means that the cancer is possible to detect and it’s bigger than 4 cm.

If there is a case of T2b stage of the cancer, the tissues of the parametria are invaded in as well.

If you’re diagnosed with T3 stage of the cancer, the tumor has already invaded in either the lower part of the vagina or the walls of the pelvis. Besides, there is a possibility of the cancer blocking the uterus (exactly those tubes that carry urine from your kidneys to the bladder).

  • T3a implies that the tumor has already invaded in the lower part of the vagina. However, the walls of the pelvis haven’t yet been touched by it.
  • T3b implies that the tumor has already invaded in the walls of the pelvis. Besides, metastases may be blocking one or both ureters (doctors usually refer to this situation as hydronephrosis).

In case T4 stage is detected, your tumor has already had an influence on either the bladder or rectum. Moreover, it goes on growing in the outside area of the pelvis.

The Invasion of the Cancer Into the Lymph Nodes (N)

NX stage implies that it’s impossible to evaluate the nearby lymph nodes.

N0 stage indicates that the cancer hasn’t yet developed to the nearby lymph nodes.

N1 stage implies that the cancer has already attacked the nearby lymph nodes.

The Cancer Being Developed Quite Far (M)

M0 stage means that there are no metastases inside your distant organs, lymph nodes and tissues.

M1 stage means that there are metastases in distant organs (the lungs, liver etc) and lymph nodes located either in the chest or neck. Besides, you may have metastases in the peritoneum (the tissue that covers the inside of your abdomen).

The Stages According to the FIGO System and the Grouping of the Stages

Cervical Cancer Stage

To evaluate the stage of your disease, the doctors need to use information on the tumor, lymph nodes and the development of cancer in combination. The stages are classified with the help of the number 0 and Roman numerals I – IV. Sometimes, there are sub-stages that are classified with the help of letters and numbers. Actually, the FIGO stages are the same as the AJCC ones. However, the FIGO system doesn’t take into account the state of the lymph nodes up until it’s about stage III. Besides, there is no stage 0 in the FIGO system.

Stage 0 (the combination of Tis, N0 and M0) means that there are cancer cells only on the lining of the cervix. The cancer hasn’t yet invaded deeper tissues of it. Doctors also refer to the stage using the term CIS or carcinoma in situ. It is a part of cervical intraepithelial neoplasia with grade 3 ( or CIN3). Keep in mind that there is no stage 0 in the FIGO system.

Stage I (the combination of T1, N0 and M0) implies that there are metastases in the cervix, however, there is yet nothing in the outside area of the uterus. Besides, the cancer hasn’t yet attacked the nearby lymph nodes (N0) as well as the areas that are located quite far (M0).

Stage IA (the combination of T1a, N0 and M0) is the very beginning of the stage I. It means that the tumor is quite small and it can only be detected if studied under microscope.

There isn’t yet any cancer inside the nearby lymph nodes (N0) as well as in the areas located quite far (M0).

  • Stage IA1 (the combination of T1a1, N0 and M0) implies that the tumor is less than 3 mm deep (approximately 1/8 inch) and less than 7 mm wide (approximately ¼ inch). There aren’t any metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).
  • Stage IA2 (the combination of T1a2, N0 and M0) implies that the tumor is 3-5 mm deep (approximately 1/5 inch) and less than 7 mm wide (approximately ¼ inch). There aren’t any metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).
  • Stage IB (the combination of T1b, N0 and M0) implies that it’s about the cancers that can be detected without using microscope and the ones that are only possible to detect with the help of microscope. The last case implies that the tumors should invade deeper than 5 mm (approximately 1/5 inch) in the connective tissue of the cervix and they are wider than 7 mm. At the same time, there are no metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).
  • Stage IB1 (the combination of T1b1, N0 and M0) implies that even though the cancer can be detected, the tumor is not bigger than 4 cm (approximately 1 3/5 inches). At the same time, there are no metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).
  • Stage IB2 (the combination of T1b2, N0 and M0) implies that the cancer can be detected and the tumor is bigger than 4 cm. At the same time, there are no metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).

Stage II (the combination of T2, N0 and M0) means that your tumor has developed beyond the cervix as well as the uterus. However, the walls of the pelvis and the lower part of the vagina haven’t yet been affected.

Stage IIA (the combination of T2a1, N0 and M0) implies that the tumor hasn’t had influence on the tissues located closely to the cervix. This area is, as a rule, called the parametria. However, there may be metastases in the upper part of the vagina. Still, there are no metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).

  • If you’re dealing with the stage IIA1(the combination of T2a1, N0 and M0), it means that even though the cancer can be detected, the tumor is not bigger than 4 cm (approximately 1 3/5 inches). Besides, there are no metastases in the nearby lymph nodes (N0) or the areas that are located quite far (M0).
  • If you’re dealing with the stage IIA2(the combination of T2a2, N0 and M0), it means that the tumor is possible to detect and it’s bigger than 4 cm.
  • If you’re dealing with the stage IIB(the combination of T2b, N0 and M0), it means that the tumor has invaded in the parametria.

If you’re diagnosed with stage III (the combination of T3, N0 and M0), be warned that the cancer has already attacked either the lower part of the vagina or the walls of your pelvis. Besides, as a result of the tumor’s presence, the ureters may be blocked. These are exactly these tubes that are responsible for the carrying of your urine from your kidneys to the bladder. However, there is yet no cancer present in the nearby lymph nodes (N0) as well as the areas located quite far (M0).

  • If you’re diagnosed with stage IIIA (the combination of T3a, N0 and M0), it means that the cancer has invaded in the lower third of the vagina. However, the walls of the pelvis stay untouched by it. Besides, there is no cancer inside your lymph nodes (N0) as well as the areas located quite far (M0).
  • If you’re diagnosed with stage IIIB (the combination of either T3b, N0 and M0 or T1-T3, N1 and M0). Such like case implies one of the following explanations:
  • your cancer has invaded inside the walls of the pelvis. Besides, it is likely to have blocked one or both ureters (this case is referred to as hydronephrosis).
  • your cancer has invaded inside the lymph nodes located in the pelvis (N1). However, there are no metastases in the areas located quite far (M0). Pay attention to the fact that your tumor may be of any size and it may attack either the lower part of the vagina or the walls of the pelvis as well (T1-T3).

If you’re dealing with stage IV, it means that you’re facing the most advanced stage of the cancer. In this case, there are metastases either in the closely located organs or other parts of your organism.

  • If you’re dealing with stage IVA (the combination of T4, N0 and M0), it implies that the cancer has invaded in either the bladder or the rectum. These are exactly the organs that are located quite close to your cervix (T4). However, there is no cancer inside your nearby lymph nodes (N0) as well as the areas that are quite far (M0).
  • If you’re dealing with stage IVB (the combination of any T and N and M1), it implies that the cancer has had an influence on the distant areas located outside the pelvic area. The list of such like organs involves the lungs and liver.

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