Cervical Cancer Stages

Doctor talking to patient about cervical cancer

Cervical cancer stages are identified with a complete clinical exam that is performed after a diagnosis is confirmed. Cancer can be staged through a combination of imaging, physical exams, biopsies, tissue diagnoses and sometimes surgery. The results are used to determine the size of any tumors, whether the cancer has invaded tissues in and around the cervix and whether it has spread to other areas of the body.

Staging is important because it drives diagnosis, prognosis and treatment. For staging cervical cancer, most doctors use the FIGO staging system, named for its developers at the International Federation of Gynecology and Obstetrics. This system—which classifies cancer into one of four numbered stages—is based on clinical results such as physical exams and diagnostic testing, and the FIGO stage plays a big role in shaping the patient’s treatment plan.

 A different staging system is used for tracking cervical cancer survival rates. Known as the Surveillance, Epidemiology, and End Results (SEER) staging system, this way of categorizing cervical cancer cases has only three stages based on how far the cancerous cells have spread:

  • Localized – no spread outside of the cervix or uterus
  • Regional – growth beyond the cervix and uterus to nearby lymph nodes
  • Distant – spread to nearby organs or more distant parts of the body
Staging is important because it drives diagnosis, prognosis and treatment.

The American Cancer Society uses the SEER database maintained by the National Cancer Institute to provide survival rate statistics for cervical cancer patients at each SEER stage. It’s important to remember that these rates are based on averages and do not consider specific data, such as the patient’s age, type of cervical cancer and overall health condition. Moreover, the survival rates for all cervical cancer stages are likely to improve as more innovative and effective treatments are developed. On average, Moffitt's cervical cancer treatment outcomes exceed 1.5 times the national average.

Below, we discuss cervical cancer staging systems as they relate to both treatment decisions and survival rates.

How cervical cancer is staged

FIGO cervical cancer stages are numbered from 1 to 4, with stage 0 sometimes used to refer to abnormal cells that have not grown past the surface layer of the cervix. The numbers are used to describe the cancer’s progression, with the lowest being the least advanced. Stages 1 through 4 are further broken down with letters (for instance, stage 1A or 1B) based on the size of the cancer. Here are brief descriptions of the main FIGO cervical cancer stages:

Stage 0 cervical cancer

Stage 0 is also commonly called “carcinoma in situ.” This stage is sometimes considered “pre-cancer” because the abnormal cells are only at the surface layer of the cervix and have not moved into deeper layers of cells. When cancerous cells are detected at this early stage, they can generally be successfully destroyed with proper treatment.

Stage 1 cervical cancer

At stage 1, cancer has grown past the surface of the cervix to deeper layers of tissue. In some cases, it may have moved into the body of the uterus, but it has not progressed outside of the uterus. It has not spread to lymph nodes or distant sites.

Generally, cervical cancer that is detected and treated in the early stages is considered highly curable. Many medical professionals consider a patient “cured” if her cancer becomes undetectable and doesn’t return for at least five years, and there are some patients whose cervical cancer never comes back. However, there are never any guarantees that cancer will not return. This is why some medical professionals refer to cancer that has become undetectable as “in remission” instead of cured.

The five-year relative survival rate for women who received treatment after being diagnosed with localized cervical cancer (which would include stage 1 cases) is over 90%. This means women diagnosed with stage 1 cervical cancer are about 90% as likely to live for another five years as women who don’t have the disease.

Stage 2 cervical cancer

When cervical cancer reaches stage 2, it has spread beyond the cervix and uterus, but it has not yet grown to the lower third of the vagina or the pelvic wall. The cancer may or may not have spread to nearby lymph nodes.

Stage 3 cervical cancer

Once cervical cancer progresses to stage 3, the cancerous cells have spread to the lower third of the vagina or to the pelvic wall. At this stage, the cancer could cause hydronephrosis (swelling of a kidney) or could be blocking the ureters, which carry urine to the bladder from the kidneys. The cancer may or may not have spread to nearby lymph nodes.

According to the SEER staging system, both FIGO stages 2 and 3 cervical cancer are considered to have spread regionally. The overall five-year relative survival rate for cervical cancer patients at these stages is 58%. However, the five-year relative survival rate for some stage 2 patients who receive treatment is often much higher.

Stage 4 cervical cancer

Stage 4 cervical cancer has spread to the bladder, rectum or out of the pelvis. It may or may not have invaded the lymph nodes. More advanced stage 4 cervical cancer, also known as metastatic cervical cancer, can spread to distant organs, such as the lungs, liver, bones or distant lymph nodes.

Stage 4 metastatic cervical cancer life expectancy

The relative five-year survival rate for patients with metastatic cervical cancer is about 18%. Historically, even with treatment, patients in the most advanced stage of cervical cancer rarely live more than a year or two.

However, as with all prognoses, an individual metastatic cervical cancer patient’s life expectancy can vary depending on the type of cervical cancer she has and other factors. What’s more, extending the life expectancy of stage 4 cervical cancer patients is the subject of ongoing research, including clinical trials that assess the effectiveness of new therapies and combinations of therapies. Five-year survival rate statistics track the outcomes for patients diagnosed and treated for five years, so they will not reflect any improvements made by the most recent cancer treatment options.

How does cervical cancer spread?

Staging cervical cancer for treatment purposes is related to whether and how far the malignancy has spread. Exactly what does that mean? When a cancerous tumor grows so large that it expands beyond its origination site, the malignancy is said to have spread or metastasized. In the case of cervical cancer, this happens in three ways:

  • By invading the vagina, bladder, rectum or other tissues near the uterus and vagina
  • By spreading to the lymph nodes in the pelvic area
  • By traveling through the bloodstream to distant parts of the body, such as the lungs, brain and bones, although this is the least common method of metastasis

Fortunately, for most patients, cervical cancer is slow-growing, and it can sometimes take several years for the abnormal cells to develop into invasive cancer. That’s why every woman between the ages of 21 and 65 should undergo routine screenings for cervical cancer.

How treatable is cervical cancer?

Like most cancers, when diagnosed in the early stages, cervical cancer is considered to be quite treatable. For Stage 1 cervical cancer, surgery is often the first course of action to remove either all or a portion of the cervix. In some cases, the surgery can include removing the uterus (a procedure known as a hysterectomy) and/or the upper part of the vagina. If specialists suspect the cancer has invaded nearby lymph vessels, the surgery may also include taking out the pelvic lymph nodes.

Treatment of early-stage cervical cancer often depends on the patient’s age and desire to conceive and bear children. For women who don’t want to maintain fertility, post-surgery radiation therapy may be recommended to kill any lingering cancer cells.

For stage 2 cervical cancer as well as some more advanced cases of stage 1, treatment may include a combination of radiation and chemotherapy in addition to surgery.

For stages 3 and 4, treatment is usually a combination of chemotherapy and radiation. For some cases of cervical cancer that have not responded to initial treatment or have come back, cancer specialists may recommend immunotherapy.

Patient talking about cervical cancer treatment

Moffitt Cancer Center’s approach to cervical cancer treatment

At Moffitt Cancer Center, each patient’s cancer staging is one of many factors that are reviewed in detail during regular tumor board meetings with our cancer specialists. In this way, each patient receives the benefit of multiple expert opinions, all of which are incorporated into a highly individualized treatment plan. At Moffitt, we are proud to provide the very latest in every aspect of cancer care, including screening, diagnosis, treatment and supportive care.

The Gynecologic Oncology clinic at Moffitt offers a broad spectrum of cervical cancer treatments, including highly complex, robot-assisted surgeries. Our patients also have access to clinical trials that can provide them with advanced treatments that are not yet available at other cancer hospitals. As a result of our expertise and individualized approach to cancer diagnosis and treatment, we have achieved five-year survival rates that are significantly higher than the national average for patients with cervical cancer. Moreover, our most impressive outcome statistics are for cervical cancer patients in the more-difficult-to-treat intermediate and advanced stages of the disease.

After a cancer diagnosis, every day counts. We have disrupted the traditional patient care model to connect every new patient with a cancer expert within a day of their reaching out to us so we can start treatment as soon as possible. If you’d like to learn more about our approach to diagnosing and treating cervical cancer, or if you have questions about your prognosis or need diagnostic testing, please call 1-888-663-3488 or complete a new patient registration form. No referral is needed to seek treatment at Moffitt.

References

American Society of Clinical Oncology – Cervical Cancer Stages
American Cancer Society – Survival Rates for Cervical Cancer
MedicalNewsToday – Is Cervical Cancer Curable?
American Cancer Society – Treatment Options for Cervical Cancer by Stage
University of Rochester Medical Center – How Does Cervical Cancer Spread?