What to know about FIGO staging for cervical cancer

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FIGO stage I cervical cancer refers to cancer that is limited to the cervix and has not spread to nearby tissues or organs.

There are two FIGO sub-stages of stage I cervical cancer. These include:

• Stage IA: The cancer is in its early stage and has not spread beyond the cervix. It is only visible with a microscope. There are two subdivisions of this stage:
  • Stage IA1: The cancer is less than 3 millimeters (mm) deep into the cervix.
  • Stage IA2: The cancer is between 3 and 5 mm deep into the cervix.
• Stage IB: The cancer is still confined to the cervix but has invaded further than 5 mm deep. There are three subdivisions of this stage:
  • Stage IB1: The cancer measures 2 centimeters (cm) or smaller.
  • Stage IB2: The cancer measures between 2 and 4 cm.
  • Stage IB3: The cancer measures more than 4 cm.

Outlook

The outlook for a person with cervical cancer depends on several factors, including:

• the stage of the cancer
• the size and location of the tumor
• the person’s age and overall health
• type of treatment received

The 5-year relative survival rate for localized cervical cancer is 91%. However, regular follow-up care and surveillance are essential to monitor for any signs of recurrence or spread of cancer.

A relative survival rate helps give an idea of how long a person with a particular condition will live after receiving a diagnosis compared with those without the condition.

For example, if the 5-year relative survival rate is 91%, it means that a person with the condition is 91% as likely to live for 5 years as someone without the condition.

It is important to remember that these figures are estimates. A person can consult a healthcare professional about how their condition is going to affect them.

In stage II cervical cancer, the cells have spread to the tissue around the uterus or the upper two-thirds of the vagina.

There are two FIGO sub-stages of stage II cervical cancer. These include:

• Stage IIA: Cancerous cells have spread to the upper two-thirds of the vagina. This stage is further divided into two sub-stages:
  • Stage IIA1: The cancer measures under 4 cm.
  • Stage IIA2: The cancer measures more than 4 cm.
• Stage IIB: Cancer cells have spread to the tissue around the uterus.

Outlook

The 5-year relative survival rate is 60% for cervical cancer that has spread to nearby tissues or organs.

At this stage, the cancer involves the lower third of the vagina. It may have extended to the pelvic wall or certain lymph nodes. The kidney function may also be affected.

There are three FIGO sub-stages of stage III cervical cancer. These include:

• Stage IIIA: The cancerous cells have spread to the lower third of the vagina but have not yet spread to the wall of the pelvis.
• Stage IIIB: The pelvic wall contains cancerous cells. In this stage, the kidneys may enlarge or stop working, and the cancerous mass may be large enough to block one or both ureters.
• Stage IIIC: This stage has two substages, depending on which lymph nodes the cancerous cells have spread to.
  • Stage IIIC1: This stage involves the lymph nodes in the pelvis.
  • Stage IIIC2: This stage involves abdominal lymph nodes near the aorta.

Outlook

If the cancer cells have spread to nearby organs or lymph nodes, the 5-year relative survival rate is 60%.

Despite the lower survival rate, it is important to remember that every case is different. Some people may respond better to treatment than others, and factors such as the person’s overall health and response to treatment can also affect the outcome.

In this stage, the cancer has spread further than the pelvis. This stage is known as metastatic cervical cancer, as the cells are located far from the cervix. It may have spread to the bladder lining, wall of the rectum, or other distant body parts.

There are two sub-stages of stage IV cervical cancer:

• Stage IVA: The cancer cells have spread to pelvic organs like the rectum or bladder.
• Stage IVB: The cancer cells have spread from the cervix to distant parts of the body, such as the bones, distant lymph nodes, or the lungs.

Outlook

The 5-year relative survival rate is around 19% when cervical cancer is discovered after it has progressed to a distant area of the body.

The treatment can depend on the stage of cervical cancer.

Stage IA1

Treatment includes:

• Conization: This involves removing a cone-shaped piece of abnormal tissue from the person’s cervix.
• Total hysterectomy: This refers to the removal of the uterus.

Stage IA2

Treatment includes:

• A modified radical hysterectomy with a lymphadenectomy: A surgeon will remove the uterus, cervix, and upper part of the vagina. They may also remove the nearby tissues and ligaments. The surgeon will also remove the lymph nodes.
• Radical trachelectomy: This procedure involves removing the cervix, nearby tissue, and upper part of the vagina.

Doctors may also administer radiation therapy.

Stages IB and IIA

Treatment includes:

• radiation therapy combined with chemotherapy
• radiation therapy without chemotherapy
• radical hysterectomy combined with the removal of pelvic lymph nodes
• radical trachelectomy

IIB, III, and IVA

Treatment options include:

• radiation therapy alongside chemotherapy
• removal of the pelvic lymph nodes

Many people will receive a combination of internal and external radiation therapy.

IVB

The treatment approach for stage IV cervical cancer is often individualized based on the person’s specific situation.

The treatment plan may involve a multidisciplinary team of doctors and healthcare professionals. Oftentimes, it involves palliative care to improve the quality of life and make the person as comfortable as possible.

Healthcare professionals may use the FIGO staging system to classify cervical cancer based on the size of the tumor, the location, and how far it has spread.

The treatment options and the overall outlook for a person with cervical cancer depend on the stage.