Cervical cancer--cancer of the portion of the uterus lying within the upper vagina--affects approximately 250,000 women in the United States, according to data published in 2007 by the National Cancer Institute. Patients with cervical cancer carry an overall five-year survival rate of approximately 70 percent, with the rate increasing or decreasing depending on the cancer's stage of progression in the body. Doctors determine the stage of the disease at the time of cancer diagnosis.
Pathologic Staging
Staging of cervical cancer identifies how far the tumor has spread in the body, which is important in guiding treatment and prognosis. Patients with tumors limited to the cervix may have localized treatment that spares the rest of the uterus, while tumors that have spread to the lymph nodes require more aggressive cancer treatment. The International Federation of Gynecology and Obstetrics system (FIGO) and the American Joint Committee on Cancer staging system (AJCC) both utilize the size and extent of the tumor, presence or absence of lymph node involvement, and presence or absence of spread to distant tissues as criteria for cervical cancer staging.
Each system identifies four stages of cervical cancer--Stages I through IV--, each of which describes progressively more advanced disease. The AJCC recognizes a fifth stage, Stage 0.
Stage 0
Stage 0, classified by the AJCC for cervical cancer in-situ without spread into lymph nodes or distant metastases, remains absent from the FIGO cancer staging system. The term in-situ means pre-cancerous, where cancerous cells stay limited to the surface of the cervix, not yet invading deeper tissues of the uterus. These tumors are associated with a 100-percent five-year survival rate.
Stage I
Stage I tumors, ranging from a 70- to 95-percent five-year survival rate, fall into Stage IA tumors and Stage IB tumors based on whether they are seen with or without a microscope and how deep and wide they spread. All of these tumors involve the surface of the cervix and the deeper tissues of the uterus, may or may not involve regional lymph nodes, and are without distant metastatic disease.
Stage II
Stage II tumors, ranging from a 65- to 95-percent five-year survival rate, include tumors that have spread from the cervix through the uterus (Stage IIA) and then into the tissues surrounding the uterus (Stage IIB) without involving the pelvic walls or the lower vagina. Neither category of Stage II tumors involves distant metastatic sites, although each may include regional lymph node disease.
Stage III
Stage III tumors involve the pelvic wall and lower portion of the vagina and sometimes involve tissues surrounding the uterus. Tumors may involve the ureters, which carry urine from the kidneys, impairing kidney function or causing the kidney to enlarge. Cancers of this stage may involve regional lymph nodes. The five-year survival rate for patients is approximately 40 to 60 percent and is influenced by the site of invasion and extent of lymph node disease.
Stage IV
Regardless of the tumor characteristics and size, extent of disease, or regional lymph node involvement, Stage IV tumors include bladder or colon invasion and/or distant metastatic disease. The five-year survival for these patients falls to approximately 20 to 30 percent.
