Cervical Cancer

FIGO staging of cancer of the cervix uteri (2018)

StageDescription
IThe carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
IAInvasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mma
IA1Measured stromal invasion <3 mm in depth
IA2Measured stromal invasion ≥3 mm and <5 mm in depth
IBInvasive carcinoma with measured deepest invasion ?5 mm (greater than Stage IA), lesion limited to the cervix uterib
IB1Invasive carcinoma ≥5 mm depth of stromal invasion, and <2 cm in greatest dimension
IB2Invasive carcinoma ≥2 cm and <4 cm in greatest dimension
IB3Invasive carcinoma ≥4 cm in greatest dimension
IIThe carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall
IIAInvolvement limited to the upper two?thirds of the vagina without parametrial involvement
IIA1Invasive carcinoma <4 cm in greatest dimension
IIA2Invasive carcinoma ≥4 cm in greatest dimension
IIBWith parametrial involvement but not up to the pelvic wall
IIIThe carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodesc
IIIAThe carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
IIIBExtension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
IIICInvolvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c
IIIC1Pelvic lymph node metastasis only
IIIC2Para-aortic lymph node metastasis
IVThe carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to Stage IV)
IVASpread to adjacent pelvic organs
IVBSpread to distant organs

When in doubt, the lower staging should be assigned.
aImaging and pathology can be used, where available, to supplement clinical findings with respect to tumor size and extent, in all stages.
bThe involvement of vascular/lymphatic spaces does not change the staging. The lateral extent of the lesion is no longer considered.
cAdding notation of r (imaging) and p (pathology) to indicate the findings that are used to allocate the case to Stage IIIC. Example: If imaging indicates pelvic lymph node metastasis, the stage allocation would be Stage IIIC1r, and if confirmed by pathologic findings, it would be Stage IIIC1p. The type of imaging modality or pathology technique used should always be documented.
Source: Bhatla et al.