FIGO staging provides a standardized way for doctors to diagnose and measure cervical cancer.
Staging is an important part of diagnosing and treating cervical cancer, as it helps doctors determine the extent of the disease and develop an appropriate treatment plan.
One of the key tools used to diagnose and treat cervical cancer is the FIGO staging system.
FIGO staging is a system developed by the International Federation of Gynecology and Obstetrics (FIGO) to stage (or measure) cancers that affect the female reproductive system, such as cervical, ovarian, and endometrial cancers.
FIGO staging is based on three main factors:
- the size and extent of the tumor
- the involvement of nearby lymph nodes
- the presence or absence of distant metastases (spread of cancer cells from the original tumor to other parts of the body)
The stages are numbered from I to IV, with subcategories represented by letters or numbers, indicating the severity and progression of the cancer.
Why is staging cancer important?
Research shows that cervical cancer is the fourth most common cancer in women of all ages around the world. Early detection is crucial because it significantly improves the chances of successful treatment and cure.
Staging cancer helps doctors determine the size of the cancer and how far it’s spread from its original location to other parts of the body. By knowing the stage of cancer, doctors can develop a personalized treatment plan that takes into account each person’s unique situation.
The primary FIGO stages of cervical cancer are as follows:
Stage 0
Stage 0, also known as carcinoma in situ (Latin for “cancer in place”), is a precancerous condition where abnormal cells are found only on the surface of the cervix.
The recommended treatment typically involves removing the abnormal cells from the surface of the cervix.
One removal method is called a cone biopsy, which involves using a scalpel or laser to remove cone-shaped pieces of tissue from the cervix). The other removal method is called loop electrosurgical excision procedure (LEEP), which involves using a smile wire loop to remove abnormal cells from the cervix.
Stage 0 cervical cancer is usually curable with treatment, and the chances of success are very high.
Stage I
Stage 1 refers to a localized cancer that has not spread beyond the cervix.
This stage is further divided into two basic sub-stages:
- Stage 1A: The cancer cells are not visible to the naked eye and are limited to the cervix.
- Stage 1B: The cancer is visible to the naked eye and is limited to the cervix (hasn’t spread to nearby tissues or organs).
In Stage 1, the cancer is still considered to be relatively early-stage and is often curable with treatment, which typically involves surgery to remove the cancerous tissue, such as a radical hysterectomy (removing a person’s uterus) or trachelectomy (removing the cervix and upper part of the vagina).
Radiation therapy and chemotherapy may also be used in some cases.
Stage II
Stage II refers to a cancer that has spread beyond the cervix but hasn’t yet spread to the pelvic wall or to the lower third of the vagina.
Stage 2 is further divided into two sub-stages:
- Stage 2A: The cancer has spread to the upper two-thirds of the vagina but hasn’t spread to the pelvic wall.
- Stage 2B: The cancer has spread to the tissues adjacent to the cervix, such as the pelvic sidewall, but not to the lower third of the vagina.
In stage 2, the cancer has started to spread beyond the cervix, but it’s still considered a locally advanced cancer. The recommended treatment typically involves a combination of radiation therapy and chemotherapy, and in some situations, surgery.
Stage III
Stage III refers to cancer that has spread beyond the cervix and into the pelvic area.
Stage 3 is further divided into three sub-stages:
- Stage 3A: The cancer has spread to the lower third of the vagina but not to the pelvic wall.
- Stage 3B: The cancer has spread to the pelvic wall or has caused kidney problems.
- Stage 3C: The cancer has spread to nearby lymph nodes.
The recommended treatment for stage 3 cervical cancer typically involves a combination of radiation and chemotherapy, with the possibility of surgery.
Stage IV
Stage 4 refers to cancer that has spread beyond the pelvis to other parts of the body, such as the bladder or rectum.
Stage 4 is further divided into two sub-stages:
- Stage 4A: The cancer has spread to nearby organs, such as the bladder or rectum.
- Stage 4B: The cancer has spread to other parts of the body, such as the lungs, liver, or bones.
The recommended treatment for stage 4 cervical cancer typically involves a combination of radiation therapy, chemotherapy, and palliative care. The goal of treatment at this stage is often to manage symptoms and improve quality of life, rather than to cure the cancer.
The staging process may involve a combination of physical exams, imaging tests (such as CT, MRI, or PET scans), and biopsies to determine the extent of the cancer.
There are several types of equipment used for diagnostic testing for cervical cancer, including:
- Speculum: A device used to hold open the walls of the vagina to allow the doctor to examine the cervix.
- Colposcope: A specialized instrument that allows the doctor to examine the cervix under magnification and a bright light.
- Biopsy instruments: An instrument that can remove small tissue samples for further testing.
- Pap smear (cytologic screening): A common screening test involving a small brush or spatula to collect cells from the surface of the cervix, which are then examined under a microscope.
Research shows that population-based pap smear screening programs have reduced the rates of cervical cancer in developed countries.
The stages of cervical cancer that are considered curable are primarily the earlier stages of the disease (stages I and II). In these stages, the cancer is confined to the cervix or has spread only to nearby lymph nodes.
Cervical cancer is often treatable, and many women can make a full recovery with early detection.
The FIGO system provides a standardized way for doctors to determine the severity of cervical cancer as well as a way to explain to women their outlook, so they can make informed decisions about their treatment options.