A diagnosis of cervical cancer is just one aspect in determining your treatment options and other paths forward. Your oncologist will next go through a process of staging, which determines the extent of the cancer, including whether it has spread beyond the cervix.

In this article, we explain the stages of cervical cancer, how they’re determined, and what they mean when considering your treatment options and overall outlook.

Illustration showing the first two stages of cervical cancerShare on Pinterest
The above illustration depicts the first two stages of cervical cancer. Illustration by Diego Sabogal.

There are four main stages of cervical cancer. The lowest stages are the less severe form of the disease. Higher stages indicate more advanced cervical cancer that has spread.

To stage cervical cancer and other cancers of the female reproductive system, doctors use guidelines from the International Federation of Gynecology and Obstetrics (FIGO) staging system. These stages include:

FIGO stage 1

Stage 1 is the earliest stage of cervical cancer. At this point, the cancer may have grown from the surface of the cervix to deeper tissues, but hasn’t spread to lymph nodes or distant organs.

Stage 1 is broken down into further classifications:

Stage 1A A small amount of cancer may be noted under microscopic examination.
Stage 1A1 The cancer may still only be seen under a microscope, and it’s less than 1/8 inch deep.
Stage 1A2 The cancer may be between 1/8 and 1/5 inches deep upon microscopic exam.
Stage 1B The cancer may be deeper than 1/5 inches, but is in the cervix only.
Stage 1B1 The cancer may be 1/5 inches deep, but less than 4/5 inches (2 cm) in size.
Stage 1B2 The cancer may be between 2 and 4 cm in size.
Stage 1B3 The cancer may still be in the cervix only, and it may be larger than 4 cm.

FIGO stage 2

In the next major stage of cervical cancer, malignant cells may have spread outside of the cervix and uterus, but not beyond the lower vagina or pelvic wall. The cancer hasn’t spread to lymph nodes or distant organs.

Stage 2 is broken down into further classifications:

Stage 2A The cancer may have spread outside the cervix or uterus, but not into the parametrium (tissues beside the cervix).
Stage 2A1 The cancer may have spread beyond the cervix, but it’s still less than 4 cm in size.
Stage 2A2 The cancer may be larger than 4 cm.
Stage 2B The cancer may have spread to the parametrium.

FIGO stage 3

In stage 3 cervical cancer, malignant tumors have spread to the pelvic wall and lower vagina. The cancer may also block the ureters, which carry urine from your kidneys to your bladder. It may also have spread to the lymph nodes, but not distant sites.

Stage 3is broken down into further classifications:

Stage 3A The cancer may have spread to the lower vagina, but not the pelvic wall or lymph nodes.
Stage 3B The cancer hasn’t spread to the lymph nodes, but it has metastasized to the pelvic wall and may be blocking one or both ureters.
Stage 3C The cancer may have spread to nearby lymph nodes. It may also be any size in this stage.

FIGO stage 4

This is the most serious stage of cervical cancer. The cancer may have spread to the bladder or rectum, as well as the lungs, bones, or other distant areas.

Stage 4 classifications include:

Stage 4A Cancer has spread to the rectum or bladder or is growing outside the pelvis.
Stage 4B Cancer has spread to distant sites outside the pelvic area.

Staging is one of the most important diagnostic tools doctors used to determine cancer treatment and outlook.

Factors that affect staging

To stage cervical cancer, your doctor will consider the following factors:

  • how far cancer has grown into your cervix
  • whether the cancer has spread (metastasized) into nearby areas
  • whether the cancer has spread to nearby lymph nodes
  • the presence of cancer in distant organs

Diagnostic tests used to determine staging

Additionally, before clinical staging, your doctor may perform a combination of the following:

  • physical exam
  • imaging tests, X-rays, MRIs, PET or CT scans
  • biopsy, which involves taking a small sample from the cervix or nearby tissues and looking for cancerous cells under a microscope
  • a lymph node biopsy
  • cystoscopy, which is a procedure that looks for larger tumors in your urethra or bladder
  • proctoscopy, a type of procedure that helps your doctor find larger tumors. It’s exclusive to the rectum

Doctors use staging to determine the size and extent of cervical tumors, as well as whether they have spread beyond the cervix.

Metastatic cervical cancer means that the cancer has spread to lymph nodes, tissues, and organs, and it may be more difficult to treat. Metastasis typically occurs in the later stages of cervical cancer.

When considering cancer, the best outcomes tend to be when the disease is diagnosed at an earlier stage.

One 2018 study of the FIGO staging system for cervical cancer found that the highest rates of survival were noted in stages 1B1 and 1B2, possibly due to the presence of lower grade tumors. In general, low grade tumors grow much slower than other types of cancer cells.

According to the American Cancer Society, the overall 5-year relative survival rate for individuals diagnosed with cervical cancer between 2011 and 2017 was 66 percent.

The rate was highest (92 percent) in earlier, more localized stages. As the cancer spread to distant areas, these 5-year survival rates decreased to 18 percent.

Researchers estimate that distant metastasis of cervical cancer is uncommon. However, up to 35 percent of those diagnosed with cervical cancer may eventually develop secondary lung tumors.

While every situation is different, such statistics underscore the connections between early diagnosis and longer life expectancy when considering cervical cancer. Communities should consider increased healthcare access that also encourages individuals to see a doctor if they’re experiencing unusual symptoms.

Early symptoms of cervical cancer

In its earliest stages, cervical cancer may be treated before it has spread to nearby lymph nodes and distant organs. You may not experience symptoms until the cancer has spread. You should see a doctor right away if you’re experiencing any of the following symptoms:

  • unusual vaginal discharge
  • vaginal bleeding
  • bleeding after intercourse
  • pain during intercourse
  • pelvic pain

Cervical cancer staging is done to help determine your treatment options for this type of cancer, as well as your overall outlook. These stages are based primarily on whether the tumors have spread outside of the cervix, but the size of the cancer is also considered.

The best outcomes tend to be cancers that are caught in earlier stages, which makes regular gynecological exams and early detection crucial.

Contact a doctor if you have concerns about any symptoms you may be experiencing.