Cancer of the Cervix

	Rules for Classification
	FIGO 1998 Staging

Rules for Classification

Staging of cervical cancer is based on clinical evaluation. The clinical staging must never be changed because of subsequent findings. When there is doubt as to which stage a particular cancer should be allocated, the earliest stage is mandatory.

The following examinations are permitted: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography and x-ray examination of the lungs and skeleton. Suspected bladder or rectal involvement should be confirmed by biopsy and histological evidence.

N.B: Findings of optional examinations such as lymphangiography, arteriography, venography, laparoscopy, ultrasound, CT scans and MRI are of value for planning therapy, but because these are not generally available, and the interpretation of results is variable, the findings of such studies should not be used in determining the clinical stage of disease. Fine needle aspiration (FNA) of scan-detected lymph nodes may be helpful in planning treatment.

FIGO 1998 Staging

Stage 0

Carcinoma in situ, cervical intraepithelial neoplasia Grade III (CIN III)

Stage I

The carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded).

Stage Ia

Invasive carcinoma which can be diagnosed only by microscopy. All macroscopically visible lesions - even with superficial invasion - are allotted to Stage 1b carcinomas. Invasion is limited to a measured stromal invasion with a maximal depth of 5.0mm and a horizontal extension of not > 7.0 mm. Depth of invasions should not be > 5.0 mm taken from the base of the epithelium of the original tissue - superficial or glandular. The involvement of vascular spaces - venous or lymphatic - should not change the stage allotment.

Stage Ia1

Measured stromal invasion of not > 3.0 mm in depth and extension of not > 7.00 mm.

Stage Ia2

Measured stromal invasion of > 3.0 mm and not > 5.0 mm with an extension of not > 7.0 mm.

Stage Ib

Clinically visible lesions limited to the cervix uteri or preclinical cancers greater than Stage Ia.

Stage Ib1

Clinically visible lesions not > 4.0 cm.

Stage Ib2

Clinically visible lesions > 4.0 cm.

Stage II

Cervical carcinoma invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina.

Stage IIa

No obvious parametrial involvement

Stage IIb

Obvious parametrial involvement

Stage III

The carcinoma has extended to the pelvic wall. On rectal examination, there is no cancer-free space between the tumour and the pelvic wall. The tumour involves the lower-third of the vagina. All cases with hydronephrosis or non-functioning kidney are included, unless they are known to be due to other cause.

Stage IIIa

Tumour involves lower-third of the vagina, with no extension to the pelvic wall

Stage IIIb

Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney

STAGE IV

The carcinoma has extended beyond the true pelvis, or has involved (biopsy-proven) the mucosa of the bladder or rectum. A bullous oedema, as such, does not permit a case to be allotted to Stage IV.

IVa

Spread of the growth to adjacent organs

Stage Ivb

Spread to distant organs

Professor Alex J. Crandon PhD (Leeds), F.R.C.O.G. (Lond), F.R.A.C.O.G., C.G.O.
Director of Gynaecological Oncology
Queensland Centre for Gynaecological Cancer
Chairman, Gynae Cancer Society of Qld