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Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of cervical cancer is one of the most important factors in evaluating treatment options.

Our cancer doctors use a variety of diagnostic tests to evaluate cervical cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information, and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

Cervical cancer is staged using the TNM system:

T (tumor): This describes the size of the original tumor.

N (node): This indicates whether the cancer is present in the lymph nodes.

M (metastasis): This refers to whether cancer has spread to other parts of the body.

Once the T, N and M scores have been determined, an overall cervical cancer stage is assigned.

Stage I (stage 1 cervical cancer): In stage I cervical cancer, the cancer is confined to the cervix, but has not spread beyond it. This stage is further separated into subcategories:

• Stage IA1: There is a very small amount of cancer, less than 3 mm deep (about 1/8-inch) and less than 7 mm wide, that can only be seen under a microscope.
• Stage IA2: The cancer is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about ¼-inch) wide.
• Stage IB1: The cancer can be seen without a microscope, but it is not larger than 4 cm (about 1 3/5 inches).
• Stage IB2: The cancer can be seen without a microscope and measures greater than 4 cm.

Stage II (stage 2 cervical cancer): Stage II cervical cancer means that the cancer has grown beyond the cervix and uterus but has not reached the walls of the pelvis or the lower part of the vagina. In this stage of cervical cancer, the disease has not spread to lymph nodes or distant sites. Stage II has two additional subcategories:

• Stage IIA: The cancer has not spread into the tissues next to the cervix, the parametria, but it may have grown into the upper part of the vagina.
• Stage IIB: The cancer has spread into the tissues next to the cervix, the parametria.

Stage III (stage 3 cervical cancer): Stage III cervical cancer means that the cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to distant sites. This stage is separated into two subcategories:

• Stage IIIA: 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 have spread to the lymph nodes.
• Stage IIIB: The cancer has grown into the walls of the pelvis and/or has blocked both ureters, but it has not spread to distant sites.

Stage IV (stage 4 cervical cancer): In this cervical cancer stage, the disease has spread to nearby organs or other parts of the body. Stage IV is separated into two subcategories:

• Stage IVA: The cancer has spread to the bladder or rectum, but not to distant sites.
• Stage IVB: The cancer has spread to organs beyond the pelvis, such as the lungs or liver.

Recurrent cervical cancer Recurrent cervical cancer occurs when the cancer is detected months or years after the completion of an initial cancer treatment regimen, which may have included surgery, radiation therapy and/or chemotherapy. The recurrence of cervical cancer may be a local recurrence, which is contained to the cervix region. A metastatic recurrence occurs when the cancer has spreads to other organs, such as the kidney, bladder or lymph nodes. This recurrence happens when the cervical cancer cells break off from the original tumor and travel to other parts of the body through the lymphatic or circulatory system. The cells then reattach at a new location. When the disease appears in another part of the body, it may be referred to as regional or distant recurrence.

Symptoms of recurrent cervical cancer vary from patient to patient. Signs and symptoms of local cervical cancer recurrence may include:

• Bleeding between periods, after sexual intercourse or after menopause
• Periods that are heavier and last longer than usual
• Unusual vaginal discharge that may be watery, pink or foul-smelling
• Pelvic pain or pain during intercourse
• Leakage of urine from the vagina

Signs and symptoms of distant cervical cancer recurrence may include:

• Weight loss
• Fatigue
• Back pain
• Leg pain or swelling
• Bone pain that does not go away

Follow-up appointments with your oncologist may help detect cervical cancer relapse early. Your doctor may ask you about symptoms or problems that you may be experiencing. The doctor may perform a pelvic examination and a Pap smear. Further lab and/or imaging tests may also be necessary.

A number of treatment options are available for cancer that has relapsed, especially when it is detected early. An estimated 35 percent of patients with invasive cervical cancer develop persistent or recurrent disease following treatment. The recurrent cervical cancer rate is lower for those with early-stage disease. Most cancer recurrences occur within two years of treatment.

Next topic: How is cervical cancer diagnosed?