Cervical cancer diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization.
TNM staging
The TNM staging system for cervical cancer is analogous to the FIGO stage.
- Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
- Stage I - limited to the uterus
- IA - diagnosed only by microscopy; no visible lesions
- IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
- IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
- IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
- IB1 - visible lesion 4 cm or less in greatest dimension
- IB2 - visible lesion more than 4 cm
- IA - diagnosed only by microscopy; no visible lesions
- Stage II - invades beyond cervix
- IIA - without parametrial invasion, but involve upper 2/3 of vagina
- IIB - with parametrial invasion
- Stage III - extends to pelvic wall or lower third of the vagina
- IIIA - involves lower third of vagina
- IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
- IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
- IVB - distant metastasis
Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for most other cancers.
For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage but is not to replace the original clinical stage.
For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used.