Cervical Cancer

Overview and Staging

Cervical cancer develops in the cervix, which is the lower, narrow end of the uterus leading to the vagina. It is often caused by human papillomavirus (HPV), a sexually transmitted virus. HPV is so common that it develops at some point in nearly all sexually active people, both women and men. Cervical cancer grows slowly and may not cause symptoms, but it can be detected with regular Pap tests and HPV testing.

Most cervical cancers (about 80 to 90 percent) are squamous cell carcinomas that start in the squamous cells covering the surface of the portion of the cervix closest to the vagina (known as the exocervix). The remaining cases are usually adenocarcinomas that arise from gland cells in the portion of the cervix closest to the uterus (known as the endocervix). The disease typically affects women younger than 50, but more than 15 percent of cases are in women older than 65.

Diagnosing and staging

An abnormal Pap test result is often the first step in diagnosing cervical cancer. After the abnormal Pap test result, you may have a colposcopy (an examination of your cervix during which a biopsy sample may be taken) or diagnostic imaging. A biopsy confirms the presence of cancer.

Staging a cancer is finding out the extent of the cancer, including the tumor size and if and how far it has spread. Determining the stage of cervical cancer is crucial in deciding which treatment options to pursue. Cervical cancer is clinically staged, which means your doctor classifies your cervical cancer based on your physical examination and diagnostic testing.

 

Cervical cancers are classified according to the tumor, node, metastasis (TNM) system developed by the American Joint Committee on Cancer. The tumor (T) is categorized according to its size and location, whether cancer cells are found in nearby lymph nodes (N), and whether cancer has metastasized (spread) (M) to other parts of the body. Once a cervical cancer has been classified, an overall stage is assigned (see Figures in Staging Illustrations).

Table 1. TNM Cervical Cancer Classifications

Classification Definition
Tumor (T)
Tis Carcinoma in situ (cancer is found only in the layer of cells lining the cervix).
T1
 
  T1a
 
     
     T1a1
     
     T1a2
 
  
  T1b
 
     
     T1b1
 
     T1b2
Cancer cells are found only in the cervix and uterus.
 
Microscopic evidence of cancer (cancer cells can be seen only when tissue is examined with a microscope).
 
Tumor is no deeper than 3 mm (about 1/8 inch) and no longer than 7 mm (about 1/4 inch).
 
Tumor is deeper than 3 mm but not deeper than 5 mm (about 1/5 inch) and is no longer than 7 mm.
 
Macroscopic evidence of cancer (cancer can be seen without a microscope); or microscopic cancers that are deeper than 5 mm or longer than 7 mm.
 
Tumor is 4 cm (a little more than 1-1/2 inches) or smaller.
 
Tumor is larger than 4 cm.
T2
 
  T2a
 
     T2a1
 
     T2a2
 
  T2b
Tumor has grown beyond the uterus but not to the pelvic wall or to the lower third of the vagina.
 
Tumor has not spread to the tissues next to the cervix (parametrial area).
 
Tumor is 4 cm or smaller.
 
Tumor is larger than 4 cm.
 
Tumor has spread to the parametrial area.
T3
 
  
  T3a
 
  T3b
Tumor has spread to the pelvic wall and/or the lower third of the vagina, and/or may block the ureters (tubes that carry urine from the kidneys to the bladder).
 
Tumor has spread to the lower third of the vagina but has not grown into the pelvic wall.
 
Tumor has grown into the pelvic wall and/or is blocking one or both ureters.
T4 Tumor has spread to the mucosa (lining) of the bladder or rectum and has grown beyond the pelvis.
Node (N)
Nx The regional lymph nodes cannot be evaluated.
N0 No tumor spread to nearby lymph nodes.
N1 Tumor has spread to nearby lymph node(s).
Metastasis (M)
M0 No distant metastasis.
M1 Cancer has spread to distant organs (such as the lungs or liver), to lymph nodes in the chest or neck, and/or to the peritoneum (the tissue lining the inside of the abdomen).

Table 2. Stages of Cervical Cancer

Stage TNM Classification
0 Tis, N0, M0
I
  IA
  IA1
  IA2
  IB
  IB1
  IB2
T1, N0, M0
T1a, N0, M0
T1a1, N0, M0
T1a2, N0, M0
T1b, N0, M0
T1b1, N0, M0
T1b2, N0, M0
II
  IIA
  IIA1
  IIA2
  IIB
T2, N0, M0
T2a, N0, M0
T2a1, N0, M0
T2a2, N0, M0
T2b, N0, M0
III
  IIIA
  IIIB
T3, N0, M0
T3a, N0, M0
T1, T2, or T3a; N1, M0, T3b, any N, M0
IVA T4, any N, M0
IVB Any T, any N, M1

 

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