Once cancer has been diagnosed, additional tests may be performed to determine whether or not the cancer has spread to other parts of the body. This is called staging. Learning the stage of the cancer helps plan treatment options.
Tests that may be performed to determine whether cancer has spread include:
- Cystoscopy or proctoscopy to check to see if cancer has spread to the urethra or bladder
- Computed tomography scan (CT), which combines multiple X-rays to provide three-dimensional clarity and show various types of tissue, including blood vessels.
- Magnetic resonance imaging (MRI), using magnets and radio waves provide three-dimensional body images. It may also be used to determine if a tumor is benign or malignant.
- Positron emission tomography scan (PET), called a PET scan. A PET scan is an imaging test that can help reveal how your tissues and organs are functioning. A small amount of radioactive material is necessary to show this activity.
The International Federation of Gynecology and Obstetrics (FIGO) believes that any staging system should be universally feasible and applicable, as well as provide a worldwide standardized classification that allows various medical centers to compare results. The major categories of the FIGO classification are as follows:
- Stage 0: Carcinoma in situ. Abnormal cells in the innermost lining of the cervix.
- Stage I: Invasive carcinoma that is strictly confined to the cervix.
- Stage II: Locoregional spread of the cancer beyond the uterus but not to the pelvic sidewall or the lower third of the vagina.
- Stage III: Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a nonfunctioning kidney that is incident to invasion of the ureter.
- Stage IV: Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum.
The FIGO stages are further categorized as follows:
- Stage Ia cervical carcinoma: Preclinical invasive carcinoma that can be diagnosed only by means of microscopy
- Stage Ib cervical carcinoma: A clinically visible lesion that is confined to the cervix uteri
- Stage Ib1: Primary tumor not greater than 4.0 cm in diameter.
- Stage Ib2: Primary tumor greater than 4.0 cm in diameter.
- Stage IIa cervical carcinoma: Spread into the upper two thirds of the vagina without parametrial invasion
- Stage IIb cervical carcinoma: Extension into the parametrium but not into the pelvic sidewall
- Stage IIIa cervical carcinoma: Extension into lower one third of the vagina, without spread to the pelvic sidewall
- Stage IIIb cervical carcinoma: Extension into the pelvic sidewall and/or invasion of the ureter, with the latter resulting in a nonfunctioning kidney or hydronephrosis
- Stage IVa cervical carcinoma: Extension of the tumor into the mucosa of the bladder or rectum
- Stage IVb cervical carcinoma: Spread of the tumor beyond the true pelvis and/or by metastasis into distant organs