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Cervical Cancer

Cervical Cancer Staging

If the biopsy shows that you have cervical cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment plan. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread, and, if so, to what 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 remove additional tissue. To learn the extent of the disease, the doctor may order some additional tests.

Tests Used to Stage Cervical Cancer

  • Chest X-rays: X-rays often can show whether cancer has spread to the lungs.
  • PET-CT scan combination: This imaging test combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The scans are done at the same time on the same machine, and the pictures are combined to make a more detailed picture than either test would make by itself.
    • 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.
    • 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, by mouth, or by enema. The contrast material makes abnormal areas easier to see.
  • 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 can 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.
  • Ultrasound: High-energy sound waves bounce off internal tissues or organs to make echoes. These echoes form a picture of the body tissues called a sonogram.
  • Complete blood count (CBC): This blood test measures a sample of blood for the number of red blood cells, white blood cells, and platelets, the amount of protein that carries oxygen in the red blood cells, and how much of the blood sample is made up of red blood cells. 
  • Blood chemistry study: A blood test that measures how much specific substances are released into the blood by organs and tissues in the body. This can include substances like electrolytes, lactate dehydrogenase, uric acid, blood urea nitrogen, and creatinine. Having higher or lower than normal amounts of something can be a sign of cervical cancer spreading.

Stages of Cervical Cancer

The stage is based on where cancer is found. These are the stages of invasive 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. This stage is divided into two stages: IA and IB,  based on how far the tumor has developed. 

Stage IA is subdivided based on the size of the tumor and how far it has developed. 

  • Stage IA1: The cancer can only be seen with a microscope, is very small, and is found in the tissues of the cervix. The tumor is about 3 millimeters or less in size. 
  • Stage IA2: The cancer can only be seen with a microscope, is very small, and is found in the tissues of the cervix. The tumor is larger than 3 millimeters but not more than 5 millimeters.

Stage IB is subdivided based on the size of the tumor and how far it has developed. 

  • Stage IB1: The tumor is 2 centimeters or smaller, and the deepest point of tumor invasion is more than 5 millimeters. 
  • Stage IB2: The tumor is larger than 2 centimeters but not larger than 4 centimeters.
  • Stage IB3: The tumor is larger than 4 centimeters.

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.

Stage IIA: Cancer has spread from the cervix to the upper two-thirds of the vagina but has not spread to the tissue around the uterus.

  • Stage IIA1: The tumor is 4 centimeters or smaller.
  • Stage IIA2: The tumor is larger than 4 centimeters.

Stage IIB: Cancer has spread from the cervix to the tissue around the uterus.

Stage III Cervical Cancer 

The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well. Cervical cancer in stage III is subcategorized dependent on how far the cancer has spread.

  • Stage IIIA: The cancer has spread to the lower third of the vagina but not into the pelvic wall.
  • Stage IIIB: The cancer has spread to the pelvic wall. The tumor may have become large enough to block the ureters or has caused the kidneys to become larger or stop working.
  • Stage IIIC: Dependent on if the cancer has spread to the lymph nodes, this sub-category is divided into stages IIIC1 and IIIC2.

Stage IV Cervical Cancer  

Stage IV cervical cancer is subcategorized into two stages (IVA and IVB) based on if the tumor has invaded the bladder or rectum or has spread to other parts of the body. Stage IV cervical cancer is also known as metastatic cancer. Metastatic cancer develops when cancer cells travel through the blood or lymphatic system and grow tumors in other parts of the body.

  • Stage IVA: The tumor has spread to the pelvic organs close by, such as the bladder or rectum. 
  • Stage IVB: The tumor has spread to other body parts, such as the liver, lungs, bones, or distant lymph nodes. 

Recurrent Cervical Cancer

The cervical 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 as metastatic cancer. Your gynecologic oncologist will run tests to determine where the cancer has returned to and how far it has spread. Treatment for recurrent cervical cancer is based on how far the cancer has spread.

Cervical Cancer Care at Virginia Oncology Associates

If you or a loved one has received a cervical cancer diagnosis, our gynecologic oncologists are ready to help guide you through the next steps. Our cervical cancer doctors work with you to create a personalized treatment plan based on your specific diagnosis. We offer a comprehensive and compassionate approach to cancer care and advanced cancer treatment options for cervical cancer offered by our team at Virginia Oncology Associates. Schedule an appointment with our gynecologic oncologist in Norfolk, Suffolk, and Chesapeake, Virginia.