Cervical Cancer: Staging and Treatment
What is staging for cancer?
Staging is the process of learning how much cancer is in your body and where it is. Tests like blood work, CT scan, MRI, biopsy, intravenous pyelogram, and colposcopy may be done to help stage your cancer. Your providers need to know about your cancer and your health so that they can plan the best treatment for you.
There are two ways to stage cervical cancer. One is the clinical stage, based on the tests listed above. The other way is the pathologic stage, based on what is found during surgery (if you need surgery). Your treatment plan will be based on the clinical stage, explained below.
Cancer staging looks at the size of the tumor and where it is, and if it has spread to other organs. The staging system for cervical cancer is the FIGO (International Federation of Gynecology and Obstetrics) staging system.
How is cervical cancer staged?
Cervical cancer is staged based on:
- If the cancer has spread, and if so, how far.
- How much cancer is in your body.
The staging systems is very complex. Below is a summary. Talk to your provider about the stage of your cancer.
Stage I: The cancer cells have grown from the surface of the cervix into deeper tissues of the cervix. Cancer has not spread to nearby lymph nodes. Cancer has not spread to distant sites.
Stage IA: There is a very small amount of cancer, and it can be seen only under a microscope. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IA1: The area of cancer can only be seen with a microscope and is less than 3 mm (about 1/8-inch) deep. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IA2: The area of cancer can only be seen with a microscope and is between 3 mm and 5 mm (about 1/5-inch) deep. It not has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IB: This includes stage I cancer that has spread deeper than 5 mm (about 1/5 inch) but is still only in the cervix. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IB1: The cancer is deeper than 5 mm (about 1/5-inch) but not more than 2 cm (about 4/5-inch) in size. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IB2: The cancer is at least 2 cm in size but not larger than 4 cm. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IB3: The cancer is at least 4 cm in size and limited to the cervix. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage II: The cancer has grown beyond the cervix and uterus but hasn't spread to the walls of the pelvis or the lower part of the vagina. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIA: The cancer has grown beyond the cervix and uterus but has not spread into the tissues next to the cervix (called the parametria). It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIA1: The cancer is not larger than 4 cm (about 1 3/5 inches). It not has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIA2: The cancer is 4 cm or larger. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIB: The cancer has grown beyond the cervix and uterus and has spread into the tissues next to the cervix (the parametria). It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage III: The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It may or may not have not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIIA: The cancer has spread to the lower part of the vagina but not the walls of the pelvis. It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIIB: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters causing kidney problems (called hydronephrosis). It has not spread to nearby lymph nodes. It has not spread to distant sites.
Stage IIIC: The cancer can be any size. Imaging tests or a biopsy show the cancer has spread to nearby pelvic lymph nodes (IIIC1) or para-aortic lymph nodes (IIIC2). It has not spread to distant sites.
Stage IV: The cancer has grown into the bladder or rectum, or to organs like the lungs or bones.
Stage IVA: The cancer has spread to the bladder or rectum, or it is growing out of the pelvis.
Stage IVB: The cancer has spread to distant organs outside the pelvic area, such as distant lymph nodes, lungs, or bones.
Treatment for Cervical Cancer
Treatment for cervical cancer depends on things like your stage of disease, medical history, current health, your goals for treatment, and other factors. The treatments used can include:
A gynecologic oncologist often treats this type of cancer. They will do your surgery and manage your chemotherapy treatments. This is different from most cancer care providers for other types of cancer.
Surgery may be used to:
- Diagnose cervical cancer.
- See how far the cancer has spread.
- Treat the cancer (mostly with early-stage cancers).
The goal of surgery is to remove as much of the tumor as possible. There are a few different types of surgeries:
- Pelvic Exenteration.
Read more about surgeries used to treat cervical cancer at OncoLink.org.
Surgery to treat cervical cancer can affect your ability to have children. One of the benefits of surgery in young women is that sometimes their ovaries can be left. This keeps them from going through menopause at an early age. Talk with your provider about your treatment options and if you want to have children in the future.
Radiation therapy is the use of high-energy x-rays to kill cancer cells. Radiation may be used:
- As the main treatment for cervical cancer.
- After surgery to kill any cancer cells left in your body.
- With chemotherapy (called concurrent chemoradiation), with the thought that the chemotherapy helps the radiation work better.
- To treat cervical cancer that has spread or that has come back after treatment (recurrent).
Radiation therapy for cervical cancer either comes from an external source (outside of the patient, called external beam radiation) or an internal source (inside the patient, known as brachytherapy). The type of radiation depends on the stage and type of tumor. Talk with your care team about whether radiation will be used in your treatment plan.
Chemotherapy is the use of anti-cancer medications to kill cancer cells. Not every case of cervical cancer will need chemotherapy.
Chemotherapy can be given:
- At the same time as radiation (concurrent chemoradiation). Examples are cisplatin, 5-fluorouracil (5-FU), or carboplatin.
- For cervical cancer that has spread or come back. Examples are cisplatin, carboplatin, paclitaxel, topotecan, docetaxel, ifosfamide, 5-fluorouracil (5-FU), irinotecan, gemcitabine, and mitomycin.
Targeted therapy medications attack certain genes and proteins found on cancer cells. Your tumor may be tested for certain genetic markers that can be treated with targeted therapy medications. Targeted therapy medications used for cervical cancer are bevacizumab and tisotumab vedotin-tftv. There are more targeted therapies being studied in clinical trials.
Immunotherapy is the use of a person's own immune system to kill cancer cells. An example of an immunotherapy medication that may be used to treat cervical cancer is pembrolizumab. Your tumor may need to be tested to make sure immunotherapy medications will work for you.
You may be offered a clinical trial as part of your treatment plan. To find out more about current clinical trials, visit the OncoLink Clinical Trials Matching Service.
Making Treatment Decisions
Your care team will make sure you are included in choosing your treatment plan. This can be overwhelming as you may be given a few options to choose from. It feels like an emergency, but you can take a few weeks to meet with different providers and think about your options and what is best for you. This is a personal decision. Friends and family can help you talk through the options and the pros and cons of each, but they cannot make the decision for you. You need to be comfortable with your decision – this will help you move on to the next steps. If you ever have any questions or concerns, be sure to call your team.
You can learn more about cervical cancer at Oncolink.org.
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