Cervical cancer diagnosis and staging

We use several tests to help diagnose cervical cancer. Your doctor will determine the right tests for your case, and ultimately only a biopsy can make a definitive diagnosis.

Examinations and tests to diagnose cervical cancer

  • Bimanual pelvic examination. Done at your doctor’s office. A Pap test is often done at the same time.
  • Biopsy. Your doctor removes a small amount of tissue for examination under a microscope by a pathologist. There are a few different types for cervical cancer:
    • Endocervical curettage (ECC).
    • A loop electrosurgical excision procedure (LEEP).
    • Conization (a cone biopsy).
  • Colposcopy. A special instrument called a colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It is not inserted into your body, and the examination is not painful.
  • HPV typing test. Similar to a Pap test. Your doctor may test for HPV at the same time as a Pap test, or after Pap test results show abnormal changes to the cervix.
  • Pap test. Your doctor takes samples of cells from your cervix for testing.
  • Pelvic examination under anesthesia.

Imaging

  • Computed tomography (CT or CAT) scan.
  • Magnetic resonance imaging (MRI).
  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan.
  • X-ray.

UCHealth uses the staging system developed by the International Federation of Obstetrics and Gynecology (FIGO) for cervical cancer.

Staging is based on a the results of a physical exam, imaging scans, and biopsies.

Stage I

The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail:

  • Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.
  • Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.
  • Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.
  • Stage IB: In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.
  • Stage IB1: The tumor 5 mm or more in depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.
  • Stage IB2: The tumor is 2 cm or more in depth and less than 4 cm wide.
  • Stage IB3: The tumor is 4 cm or more in width.

Stage II

The cancer has spread beyond the uterus to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail:

  • Stage IIA: The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.
  • Stage IIA1: The tumor is less than 4 cm wide.
  • Stage IIA2: The tumor is 4 cm or more in width.
  • Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.

Stage III

The tumor involves the lower third of the vagina, and/or has spread to the pelvic wall, and/or causes swelling of the kidney, called hydronephrosis, or stops a kidney from functioning, and/or involves regional lymph nodes. There is no distant spread. This stage also has smaller groups:

  • Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.
  • Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.
  • Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase “r” indicates imaging tests were used to confirm lymph node involvement. A lowercase “p” indicates pathology results were used to determine the stage.
  • Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.
  • Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.

Stage IVA

The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.

Stage IVB

The cancer has spread to other parts of the body.

Source: American Cancer Society