Cervical cancer staging

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Cervical cancer staging is the process of determining the extent to which cervical cancer has developed by spreading. This staging is essential for deciding the appropriate treatment strategy and predicting the patient's prognosis. The most widely used system for cervical cancer staging is the International Federation of Gynecology and Obstetrics (FIGO) system.

Overview

Cervical cancer originates in the cervix, the lower part of the uterus that opens into the vagina. Staging is a critical step after the diagnosis of cervical cancer, as it guides the treatment plan and helps in determining the outlook for recovery. The FIGO system, updated periodically, is the standard framework used globally for cervical cancer staging.

FIGO Staging System

The FIGO system classifies cervical cancer from Stage 0 (pre-cancerous or in situ) to Stage IV (cancer has spread to distant organs). The stages are defined as follows:

Stage 0

Also known as carcinoma in situ (CIS), this stage refers to pre-cancerous cells present only on the surface of the cervix.

Stage I

Cancer at this stage is confined to the cervix. Stage I is further divided into subcategories based on the size of the tumor and its depth of invasion into the cervical tissue:

• IA: Microinvasive cancer that is only visible under a microscope.
  • IA1: The invasion is no greater than 3 mm in depth.
  • IA2: The invasion is more than 3 mm but not more than 5 mm in depth.
• IB: Clinically visible lesions confined to the cervix or microscopic lesions greater than Stage IA2.
  • IB1: Visible lesion is 4 cm or smaller in size.
  • IB2: Visible lesion is larger than 4 cm.

Stage II

Cancer has spread beyond the cervix but not to the pelvic wall or the lower third of the vagina. It is divided into:

• IIA: Without parametrial invasion.
• IIB: With parametrial invasion.

Stage III

Cancer has spread to the pelvic wall and/or involves the lower third of the vagina, and/or causes hydronephrosis or non-functioning kidney. It is divided into:

• IIIA: Cancer involves the lower third of the vagina, without extension to the pelvic wall.
• IIIB: Cancer has extended to the pelvic wall and/or causes hydronephrosis or non-functioning kidney.

Stage IV

Cancer has spread beyond the pelvis or has involved the mucosa of the bladder or rectum. It is divided into:

• IVA: Spread to adjacent pelvic organs.
• IVB: Spread to distant organs.

Treatment and Prognosis

The treatment of cervical cancer varies significantly with the stage. Early stages may be treated with surgery, radiation therapy, or a combination of both. Advanced stages might require more aggressive treatments, including chemotherapy, in addition to surgery and radiation.

The prognosis of cervical cancer also heavily depends on the stage at diagnosis. Early-stage cervical cancer has a high survival rate, while advanced-stage cancer has a significantly lower survival rate.

Conclusion

Cervical cancer staging is a crucial step in the management of cervical cancer, guiding treatment decisions and providing valuable information about prognosis. The FIGO system is the standard method used worldwide for this purpose, helping healthcare professionals in the effective management of cervical cancer.