Obstetrics and Gynecology Stage Description

Cervical Cancer
 Cervical cancer is usually a squamous cell carcinoma caused by I Carcinoma confined to the uterus (including to the corpus)

IA Carcinoma diagnosed only by microscopy, with invasion of stroma ≤ 5 mm in depth and largest extension ≤ 7 mm in
HPV infection less often, it is an adenocarcinoma width)*
 Cervical cancer is the 3rd most common gynecologic cancer and IA1 Measured invasion of stroma ≤ 3 mm in depth and ≤ 7 mm in width

the 8th most common cancer among women in the US. IA2 Measured invasion of stroma > 3 mm and ≤ 5 mm in depth and ≤ 7 mm in width

 Mean age at diagnosis is about 50, but the cancer can occur as IB Clinically visible lesions confined to the cervix or microscopic lesions larger than those in stage IA2

early as age 20. IB1 Clinically visible lesions ≤ 4 cm

 Cervical cancer results from cervical intraepithelial neoplasia IB2 Clinically visible lesions > 4 cm
(CIN), which appears to be caused by infection with human II Extension beyond the cervix but not to the pelvic wall or to the lower third of the vagina
papillomavirus (HPV) type 16, 18, 31, 33, 35, or 39 IIA No obvious parametrial involvement

IIA1 Clinically visible lesion ≤ 4.0 cm in greatest dimension

Risk factors for cervical cancer include:
 Younger age at first intercourse
IIA2 Clinically visible lesion > 4.0 cm in greatest dimension

IIB Parametrial involvement

 A high lifetime number of sex partners
III Extension to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or a
 Intercourse with men whose previous partners had cervical nonfunctioning kidney
IIIA Extension to lower third of the vagina but not to the pelvic wall
cancer
 Other factors such as cigarette smoking and immunodeficiency IIIB Extension to the pelvic wall, hydronephrosis, or a nonfunctioning kidney

IV Extension beyond the true pelvis or clinical involvement of the bladder or rectal mucosa (bullous edema does not
also appear to contribute. signify stage IV)
IVA Invades mucosa of bladder or rectum and/or extends beyond true pelvis

Pathology IVB Spread to distant organs (including peritoneal spread)

CIN is graded as 1 (mild cervical dysplasia), 2 (moderate dysplasia),
Treatment
or 3 (severe dysplasia and carcinoma in situ).
 Excision or curative radiation therapy if there is no spread to
parametria or beyond
Symptoms and Signs
 CIN is usually asymptomatic. Early cervical cancer can be  Radiation therapy and chemotherapy if there is spread to
asymptomatic. The first symptom is usually irregular vaginal parametria or beyond
bleeding, which is most often postcoital but may occur  Chemotherapy for metastatic and recurrent cancer
spontaneously between menses. CIN and squamous cell carcinoma stage IA1
 Larger cancers are more likely to bleed spontaneously and may  Cone biopsy with LEEP, laser, or cold knife is usually sufficient
cause a foul-smelling vaginal discharge or pelvic pain. treatment. Hysterectomy is done for stage IA1 cancer if there are
 More widespread cancer may cause obstructive uropathy, back adverse prognostic factors (nonsquamous histology or lymphatic
pain, and leg swelling due to venous or lymphatic obstruction; or vascular invasion).
pelvic examination may detect an exophytic necrotic tumor in the Stages IA2 to IIA
cervix.  Radical hysterectomy and pelvic lymphadenectomy alone (stages
IA2 to IB1) or a radical hysterectomy and pelvic lymphadenectomy
Diagnosis with possible combined chemotherapy and pelvic radiation
 Papanicolaou (Pap) test (stages IB2 to IIA).
 Biopsy Stages IIB to IVA
 Clinical staging, usually by biopsy, pelvic examination, and chest x-  Radiation therapy plus chemotherapy (cisplatin) is more suitable
ray as primary therapy. Surgical staging should be considered to
Cervical cancer may be diagnosed during a routine gynecologic determine whether para-aortic lymph nodes are involved and
examination. It is considered in women with thus whether extended-field radiation therapy is indicated; a
retroperitoneal approach is used.
 Visible cervical lesions
Stage IVB and recurrent cancer
 Abnormal routine Pap test results
 Chemotherapy is the primary treatment, but only 15 to 25% of
 Abnormal vaginal bleeding patients respond to it and only briefly. Cisplatin is the most active
drug and the current standard, but adding topotecan appears to
Staging
improve overall response and survival.
 If the stage is > IB1, CT or MRI of the abdomen and pelvis is Prevention
typically done to identify metastases, although results are not Pap tests
used for staging. Routine cervical Pap tests are recommended every 2 yr for women
 PET with CT (PET/CT) is being used more commonly to check for aged 21 to 30. The Pap test and HPV test should be done
spread beyond the cervix simultaneously beginning at age 30. If results of both are negative,
Prognosis the screening interval should be extended to every 3 to 5 yr. Testing
In squamous cell carcinoma, distant metastases usually occur only continues until age 65.
when the cancer is advanced or recurrent. The 5-yr survival rates are HPV vaccine
as follows: Preventive vaccines that target HPV subtypes 16, 18, and sometimes
 Stage I: 80 to 90% 6 and 11 are available. These subtypes are the ones most commonly
 Stage II: 60 to 75% associated with cervical intraepithelial lesions, genital warts, and
 Stage III: 30 to 40% cervical cancer. The vaccines aim to prevent cervical cancer but do
 Stage IV: 0 to 15% not treat it. Three doses are given over 6 months.