Cervical cancer diagnostic study of choice: Difference between revisions
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Cervical cancer is staged by the [[International Federation of Gynecology and Obstetrics]] (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, [[colposcopy]], endocervical [[curettage]], [[hysteroscopy]], [[cystoscopy]], [[proctoscopy]], intravenous [[urography]], and [[X-ray]] examination of the lungs and skeleton, and cervical [[conization]]. | Cervical cancer is staged by the [[International Federation of Gynecology and Obstetrics]] (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, [[colposcopy]], endocervical [[curettage]], [[hysteroscopy]], [[cystoscopy]], [[proctoscopy]], intravenous [[urography]], and [[X-ray]] examination of the lungs and skeleton, and cervical [[conization]]. | ||
==Staging== | ==Staging== | ||
====Stage I==== | ====Stage I==== | ||
The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded) | The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded) | ||
*IA -Invasive cancer identified only microscopically. (All gross lesions even with superficial invasion are Stage IB cancers.) Invasion is limited to measured stromal invasion with a maximum depth of 5 mmband no wider than 7 mm | |||
*IA1 - Measured invasion of stroma ≤3.0 mm in depth and ≤7.0 mm width | *IA1 - Measured invasion of stroma ≤3.0 mm in depth and ≤7.0 mm width | ||
*IA2 - Measured invasion of stroma >3.0 mm and < 5.0 mm in depth and ≤ 7 mm width | *IA2 - Measured invasion of stroma >3.0 mm and < 5.0 mm in depth and ≤ 7 mm width | ||
*IB - Clinical lesions confined to the cervix or preclinical lesions greater than stage IA | |||
*IB1 - Clinical lesions no greater than 4 cm in size | *IB1 - Clinical lesions no greater than 4 cm in size | ||
*IB2 - Clinical lesions >4 cm in size | *IB2 - Clinical lesions >4 cm in size | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization.
Staging
Stage I
The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
- IA -Invasive cancer identified only microscopically. (All gross lesions even with superficial invasion are Stage IB cancers.) Invasion is limited to measured stromal invasion with a maximum depth of 5 mmband no wider than 7 mm
- IA1 - Measured invasion of stroma ≤3.0 mm in depth and ≤7.0 mm width
- IA2 - Measured invasion of stroma >3.0 mm and < 5.0 mm in depth and ≤ 7 mm width
- IB - Clinical lesions confined to the cervix or preclinical lesions greater than stage IA
- IB1 - Clinical lesions no greater than 4 cm in size
- IB2 - Clinical lesions >4 cm in size
Stage II -Involvement of up to the upper 2/3 of the vagina. No obvious parametrial involvement
- IIA1 - Clinically visible lesion ≤4.0 cm
- IIA2 - Clinically visible lesion >4.0 cm
- IIB - Obvious parametrial involvement but not onto the pelvic sidewall
Stage III - The carcinoma has extended onto the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumor and pelvic sidewall. The tumor involves the lower third of the vagina. All cases of hydronephrosis or nonfunctioning kidney should be included unless they are known to be due to other causes
- IIIA - Involvement of the lower vagina but no extension onto pelvic sidewall
- IIIB - Extension onto the pelvic sidewall, or hydronephrosis/non-functioning kidney
Stage IV The carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum
- IVA - Spread to adjacent pelvic organs
- IVB - Spread to distant organs
Comparison Between TNM Staging and FIGO Staging
Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for most other cancers.
For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage but is not to replace the original clinical stage.
For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used.