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Stages of cancer of the cervix

The stages of cervix cancer
The stages of cervix cancer
The stages are complex but important to the correct therapy recommended and thence the chances of cure. The universally accepted staging system is that derived by the International Federation of Gynaecological Oncology (FIGO).


The stage of pre-cancer is called ‘cervical intraepithelial neoplasia’ (called by the initials of the first letters, CIN – and thereafter graded in the same way, i.e. grades 1-111, as outlined above for the cancer itself). This stage should always be curable, and cases of CIN 1 or even CIN 2 may regress spontaneously. Usually, cancer of the cervix has a long period of precancer/CIN before the abnormal cells break through the cervical wall’s bottom layer (the basement membrane) and thereby gets access to routes of spread via lymphatic and blood vessels, thereafter called, invasive cancer. It is this long period of pre-cancer (CIN) that allows the high cure rate in this disease and gives credence to the whole screening programme.


The first stage of invasive cancer (Stage 1) applies to cancers that are confined to the cervix, and this stage itself is divided into two parts. Microinvasive disease (Stage 1a) is that which is only recognisable by the pathologist on microscopic review of the biopsy, and represents the very earliest form of invasion below the basement membrane of the lining cervical wall.


Stage 1b refers to all other cancers that are confined to the cervix, of whatever size, but larger than the millimetre invasion that fits into stage 1a.


Stage 2 refers to cancers that have invaded the vagina or into the tissues beside the womb (called the parametria).


Stage 3 refers to cancers that have extended down to the lower vagina or as far outwards that they have reached the pelvic side wall – this fact being ascertained both by clinical examination (vaginal and rectal examinations) and by MR scanning of the pelvis.


Stage 4 cancer refers to cancer that has spread further afield (metastasised).


The staging procedures used to ascertain the correct stage include a full clinical examination, with pelvic exam, MR scanning of the pelvis together with abdominal scanning at least in the higher stage cases and a chest x-ray and blood work-up. In the more advanced stages and before surgery the kidneys and ureters may be imaged by intravenous urography.

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