Understanding the Stages of Cervical Cancer

Cervical cancer is one of the most common forms of gynecologic cancers, with 6 in 1,000 women receiving a cervical cancer diagnosis at some point in their lifetime. In 2020, American Cancer Society’s estimates there were an estimated 14,000 new cases of invasive cervical cancer diagnosed in the United States.

With regular gynecologic screenings, your doctor may be able to identify cervical cancer earlier. The earlier cervical cancer is diagnosed the greater your chances for recovering from the disease.

What is cervical cancer?

Cervical cancer occurs when previously healthy cells in the cervix become abnormal. As they grow, they crowd healthy cells. If the abnormal cells spread to other areas of the body, it makes it harder for the body to function correctly.

Cervical cancer used to be one of the most common causes of cancer death for American women. Fortunately, because of the Pap test, rates of cervical cancer have dropped dramatically. During a Pap test, your doctor collects cervical cells for microscopic examination to find precancerous or cancerous cells. A Pap test is typically done every 3 to 5 years in your healthcare provider’s office unless you are at an increased risk for cervical cancer.  It is crucial to catch cancer early, and routine cervical cancer screening allows most women to do that.

Types of cervical cancer

There are several different types of cervical cancer, but the most common types include:

• Squamous cell cancer that affects the flat cells that cover the outside of the cervix. Squamous cell cancer affects 70-80% of those who are diagnosed.
  
• Adenocarcinoma is the second most likely form of cervical cancer and starts in the glands that produce mucus. The cervix has mucous producing cells along the inside of the passage that runs to the uterus. While only 20% of cervical cancers are adenocarcinoma-based, this form has become more common in recent years.
  
• Adenosquamous carcinoma is a rare tumor, affecting about 5-6%. Cancer treatment for adenosquamous carcinoma, adenocarcinoma and squamous cell cancer are the same.
  
• Small cell cancer is rare (3%) and proliferates. Other types of cervical cancer, like lymphomas and sarcomas, rarely occur. These types, combined with small cell cancer, are treated differently.

Cervical cancer cells are classified according to the degree of abnormality of the cells under a microscope. Cells are graded from 1 to 3. Grade 1 looks the most like normal cells, while 3 looks very abnormal.

Stage 1 cervical cancer is the most local stage of cervical cancer. In stage 1, cancer cells:

• Grow from the surface of the cervix into deeper tissues of the cervix.
• Have not spread to nearby lymph nodes
• Have not spread to distant sites

Stage 1 is split into A and B, which are further divided.

• 1A: Cancer is microscopic.
  • 1A1: The area of cancer is less than 3 mm (⅛ inch) deep.
  • 1A2: The area of cancer is between 3-5 mm (⅕ inch) deep.
• 1B: Cancer has spread deeper than 5 mm (⅕ inch) but is still limited to the cervix.
  • 1B1: The cancer is between 5 mm-2 cm (⅘ inch).
  • 1B2: The cancer is between 2 cm-4 cm (1 ⅗ inch).
  • 1B3: The cancer is at least 4 cm but remains limited to the cervix.

What are the symptoms of stage 1 cervical cancer?

Stage 1 cervical cancer often has no symptoms.  By the time symptoms appear, cancer has often advanced. If you experience any symptoms in this stage, they are likely to be vague and involve:

• Bleeding in between periods
• Pelvic discomfort

What are stage 1 cervical cancer treatments?

The treatments for stage 1 cervical cancer vary for women depending on whether they want to be able to have children in the future or not.

For those who wish to maintain fertility, the initial treatments are:

• Cone biopsy: Removing a cone-shaped piece of tissue from the cervix. Whether it warrants additional treatment depends on the results of the biopsy.
  
  • If the cone’s edge has negative margins, that means the edges do not contain cancer cells, and the surgery removed it all. You will need to be monitored to ensure the cancer doesn’t return, but no more treatment is required.
  • If the edges of the cone have positive margins (cancer cells), cancer may be left behind, which will require 1 of 2 treatments:
    
    • Repeat cone biopsy
    • Radical trachelectomy
      
      • This procedure involves removing the cervix, upper vagina and tissue surrounding the cervix.
      • Becoming pregnant after this surgery may be more difficult, and some women experience fertility issues. However, there are options to preserve fertility.
      • The pregnancy following a trachelectomy will result in a cesarean section for the birth of the baby.
    • If the cancer is in the blood or lymph vessels, and the cone biopsy comes back with negative margins, the pelvic lymph nodes will be removed.

For those who are done having children, the options are different:

• The following are surgical options that will remove the affected tissue (and some healthy tissue to prevent it from spreading).
  
  • Hysterectomy
    
    • Total (simple) hysterectomy removing the cervix and uterus.
    • A radical hysterectomy is a total hysterectomy, however, it includes the uppermost part of the vagina near the cervix (parametrium) and the pelvic ligaments that support the uterus.
  • Lymph node removal will depend on whether the lymph nodes are involved.
• Medical treatment involves radiation or drugs to treat cancer.
  
  • External beam radiation to the pelvis
  • Brachytherapy is internal radiation therapy

If cancer has spread outside the uterus (parametria) there is lymph node involvement or the tissue has positive margins, the care team may consider the following:

• EBRT
• Chemotherapy using cytotoxic (anticancer) drugs to destroy the cancer cells.
• Brachytherapy

What is the survival rate for stage 1 cervical cancer?

Approximately 92% of women with localized cervical cancer are likely to be alive in 5 years. However, if there is pelvic lymph node involvement, the survival rate is lower.

Is stage 1 cervical cancer curable?

The earlier that cervical cancer is found, the better because cervical cancer’s survival rate is high if caught before it has spread. The treatment may be challenging, but it is effective.

Stage 2 cervical cancer occurs when cancer has spread from the cervix and uterus. In stage 2, cancer cells:

• Grow beyond the cervix and uterus, but not to the pelvic or vaginal walls
• Have not spread to nearby lymph nodes
• Have not spread to distant sites

Stage 2 is split into A and B, but 2A is additionally divided.

• 2A: Cancer has grown beyond the cervix and uterus, but not into the parametrium.
• 2A1: The cancer is smaller than 4 cm (1 ⅗ inch).
• 2A2: The cancer is larger than 4 cm.
• 2B: The cancer extends beyond the cervix and uterus and has spread into the parametrium.

What are the symptoms of stage 2 cervical cancer?

Stage 2 cancer spreads to the parametrium and past the uterus to the upper vagina. Because the tumor is growing into nearby tissue, noticeable symptoms are more likely to occur at this stage.

Symptoms of stage 2 cervical cancer include:

• Abnormal uterine bleeding
• Bleeding after vaginal sex
• Bleeding after menopause
• Spotting between periods
• Having heavier or longer periods
• Unusual vaginal discharge
• Bloody discharge
• Pelvic pain

What are stage 2 cervical cancer treatments?

Typically, a combination of chemotherapy and radiation therapy is the best choice. Radiation therapy is both EBRT and chemotherapy. If internal radiation therapy occurs too, it typically involves a hospital stay for placement.  While chemotherapy supports radiation therapy, it may have benefits on its own.

What is the survival rate for stage 2 cervical cancer?

The combination of radiation and chemotherapy (chemoradiation) significantly improves the likelihood of survival at this stage, with a survival rate of approximately 61%.

Is stage 2 cervical cancer curable?

Yes, it can be cured with a combination of chemotherapy and radiation. However, in some cases, surgery may be warranted.

Stage 3 cervical cancer is when cancer has spread to the lower part of the vagina or the pelvic walls. With stage 3 cervical cancer, tumors may block the ureters (tubes that carry urine from your kidneys to the bladder). Stage 3 cervical cancer has:

• Spread to the lower part of the vagina or pelvic walls
• May have spread to lymph nodes
• Not spread to distant sites

Stage 3 is split into A, B and C. Cancer has spread to:

• 3A: The lower part of the vagina but not the pelvic walls
• 3B: The walls of the pelvis and is blocking 1 or both ureters
• 3C: Nearby pelvic or para-aortic lymph nodes - the tumor can be any size

What are the symptoms of stage 3 cervical cancer?

Stage 3 cervical cancer has symptoms because it has grown down the vaginal canal or into the pelvic wall. Symptoms of stage 3 cervical cancer are more advanced because the disease is advanced. They include:

• Problems with urination
• Leg swelling
• Problems having a bowel movement
• Bloody urine
• Painful vaginal sex
• Weight loss
• Back pain

What are stage 3 cervical cancer treatments?

The treatment of stage 3 cervical cancer includes:

• Surgery
• Radiation (EBRT or internal)
• Chemotherapy
• Targeted therapy

What is the survival rate for stage 3 cervical cancer?

A diagnosis of stage 3A has a 5-year survival rate of 35% with stage 3B at 32%. It is critical to seek expert care immediately if you are experiencing any of the symptoms above.

Is stage 3 cervical cancer curable?

Different factors influence the survival rate. It is critical to have a cancer care team that you trust to support you through understanding your unique situation.

Stage 4 cervical cancer is cancer that has grown into other organs or has metastasized. Stage 4 cervical cancer has grown into the bladder, rectum or distant organs (like the bones or lungs). Stage 4 cervical cancer is divided into A and B.

• 4A: The cancer has spread to the bladder, rectum or outside of the pelvis.
• 4B: The cancer has metastasized to organs or lymph nodes outside the pelvic area.

What are the symptoms of stage 4 cervical cancer?

Because stage 4 cancer is so invasive, symptoms are often widespread, significant and noticeable. The symptoms of stage 4 cervical cancer include any of the previous and the following:

• Lethargy
• Fatigue or weakness
• Dizziness
• Bone deficiency (pain or fractures)
• Vaginal fistula
• Shortness of breath
• Spitting up blood

What are stage 4 cervical Cancer treatments?

Because stage 4 cervical cancer is advanced, the treatments are more aggressive. However, if you decide that you do not want to undergo the above treatments, there are options for palliative care to improve your quality of life. These options include:

• Chemoradiation
  • For stage 4A cervical cancer, both chemotherapy and radiation are given. The chemotherapy drug or drugs are delivered every 4 weeks to make radiation therapy more effective. Brachytherapy can also supplement the EBRT.
• Radiation
  
  • EBRT, brachytherapy or both can also be given during palliative treatment.
• Chemotherapy
  
  • For stage 4B cervical cancer, chemotherapy may be used as palliative treatment to relieve pain and control symptoms. These drugs can be used in combination or alone.

What is the survival rate for stage 4 cervical cancer?

The 5-year survival rate for stage 3 cervical cancer is twice as high as stage 4. Once cancer has spread to a distant location, the survival rate is 16.8%.

Is stage 4 cervical cancer curable?

Stage 4 cervical cancer is not curable in many cases. However, nearly 17 in 100 women will beat stage 4 cervical cancer. It is crucial to seek expert gynecologic oncology support in a high-quality healthcare system to determine the best course of action for you and your family.

Why choose The University of Kansas Cancer Center for cervical cancer treatment?

If you are diagnosed with cervical cancer, the gynecologic oncology team at The University of Kansas Cancer Center provides comprehensive and personalized care. Our cancer center is a National Cancer Institute-designated cancer center, 1 of just 71 in the nation.

We provide you with all the resources you’ll need. The gynecologic oncologist coordinates all of your cervical cancer care, including surgery and clinical trials. Specialized gynecologic pathologists and radiologists provide expert diagnosis, and if you have any questions or problems, the registered nurse clinician or nurse practitioner is trained in gynecologic oncology to provide you with answers.

Our cancer center does more than treat your disease, we help you with other support services. Our disease-specific nurse navigator connects you with community resources, emotional support or nutritional education. The team also provides holistic resources, including a chaplain, social worker, therapist or financial counselor.

The best way to stay healthy is to see your healthcare provider regularly for routine screening. Many of the symptoms of cervical cancer can also be caused by other conditions. If you experience any signs and symptoms of cervical cancer, see a healthcare professional right away. Ignoring these symptoms may allow cancer to progress and decrease your chances at successful treatment.