| Note: FIGO staging is based on clinical examination. | Visible lesions require biopsy to confirm diagnosis.
Blood counts, including a complete blood count, renal, liver function, and HIV or syphilis serology, may be considered. | Palpation, inspection, colposcopy, endocervical curettings, hysteroscopy cystoscopy, proctoscopy, intravenous pyelography and X-ray examination of lungs and skeleton are permitted for staging. | CT, MRI and/or PET may be used. |
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| IA1/IA2: Cancer is strictly confined to the cervix. | No gross lesion seen: | Cervical cone biopsy to determine depth and width | Cone biopsies and radical trachelectomy may increase risk for prematurity if fertility is desired.
When childbearing is complete, then hysterectomy or modified radical hysterectomy for final therapy is considered. |
| A1: ≤ 3 mm depth; < 7 mm width | A1: desires fertility | A1: cone with negative margins and close follow-up
Hysterectomy after childbearing complete |
| A1: fertility not a factor | A1: hysterectomy |
| A2: > 3 mm but ≤ 5 mm depth; < 7 mm width | A2: desires fertility | A2: large cone with negative margins or radical trachelectomy with node evaluation |
| A2: fertility not a factor | A2: modified radical hysterectomy and node dissection |
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| IB: Cancer is clinically confined to the cervix, or preclinical lesion greater than A2. | Tumours < 2 cm with < 50% cervical invasion may be considered for less radical (modified radical hysterectomy) with expert consultation. | | Ureteral fistula rate is small and similar between the two modes of therapy.
Radiation causes ovarian failure in premenopausal women. |
| IB1: ≤ 4 cm | Radiotherapy with concurrent chemotherapy |
| IB2: > 4 cm | Radical hysterectomy and pelvic lymph node dissection |
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II: Cancer extends beyond the uterus, but not to the pelvic wall or lower third of the vagina.
IIA: upper two thirds of the vagina, no parametrial involvement
IIB: parametrial involvement | IIA cancers with limited extension into the upper vagina may be candidates for radical hysterectomy and pelvic lymph node dissection with expert consultation. | Radiation with concurrent chemotherapy is the primary mode of treatment. | Bladder and bowel short- and long-term side-effects of radiation. |
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III: Cancer extends onto the sidewall or lower third of the vagina.
IIIA: lower third of the vagina
IIIB: the sidewall | All patients with hydronephrosis or non-functioning kidneys are stage III unless these are known to be from another cause. | Radiation with concurrent chemotherapy is the primary mode of treatment. | |
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IV: Cancer extends beyond the true pelvis or involves the mucosa of bladder/rectum.
IVA: adjacent pelvic organ spread
IVB: distant spread | These patients require highly individualized treatment based on the exact spread of disease. | Radiation and/or chemotherapy may be considered, tailored for the individual disease pattern. | Patients with IVB (widely metastatic disease) may benefit from concurrent or solely palliative care. |
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| Recurrence after primary surgical treatment | Determined by expert consultation | If localized, there may be a role for radiotherapy or chemoradiation. | |
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| Recurrence after primary radiation treatment | Determined by expert consultation | If localized, there may be a role for surgical/exenterative therapy. | |
