Cervical cancer

Colposcopy findings

Key diagnostic criteria include:

• Abnormal vascularity

• White change with acetic acid

• Visible exophytic lesions.

Preinvasive disease

Older terminology (mild, moderate, severe dysplasia) was replaced with cervical intraepithelial neoplasia (CIN) for histologic classification based on biopsy.

• CIN 1: low grade lesion with mildly atypical cellular change in lower third of epithelium

• CIN 2: high-grade lesion with moderately atypical cellular changes confined to basal two-thirds of epithelium

• CIN 3: severely atypical cellular changes encompassing greater than two-thirds of the epithelial thickness and includes full-thickness lesions (severe dysplasia or carcinoma in situ)

International Federation of Gynecology and Obstetrics (FIGO) staging of cervical cancer[100]Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-35. http://www.ncbi.nlm.nih.gov/pubmed/30656645?tool=bestpractice.com [101]Corrigendum to "Revised FIGO staging for carcinoma of the cervix uteri" [Int J Gynecol Obstet 145(2019) 129-135]. 2019 Nov;147(2):279-80. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12969 http://www.ncbi.nlm.nih.gov/pubmed/31571232?tool=bestpractice.com

• Stage I: carcinoma confined to the cervix (extension to the uterine corpus disregarded) [Figure caption and citation for the preceding image starts]: Cervical cancer stage IFrom the collection of Richard T. Penson, MD, MRCP; used with permission [Citation ends].

  • Stage IA: invasive carcinoma diagnosed only by microscopy; maximum depth of invasion <5 mm

    • Stage IA1: stromal invasion ≤3 mm in depth

    • Stage IA2: stromal invasion >3 mm and ≤5 mm in depth

  • Stage IB: invasive carcinoma with measured deepest invasion >5 mm; lesion limited to cervix

    • Stage IB1: invasive carcinoma >5 mm depth of stromal invasion, and ≤2 cm in greatest dimension

    • Stage IB2: invasive carcinoma >2 cm and ≤4 cm in greatest dimension

    • Stage IB3: invasive carcinoma >4 cm in greatest dimension

• Stage II: carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall [Figure caption and citation for the preceding image starts]: Cervical cancer stage IIFrom the collection of Richard T. Penson, MD, MRCP; used with permission [Citation ends].

  • Stage IIA: involvement limited to the upper two-thirds of the vagina without parametrial involvement

    • Stage IIA1: invasive carcinoma ≤4 cm in greatest dimension

    • Stage IIA2: invasive carcinoma >4 cm in greatest dimension

  • Stage IIB: with parametrial involvement but not up to the pelvic wall

• Stage III: carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes [Figure caption and citation for the preceding image starts]: Cervical cancer stage IIIFrom the collection of Richard T. Penson, MD, MRCP; used with permission [Citation ends].

  • Stage IIIA: carcinoma involves the lower third of the vagina, with no extension to the pelvic wall

  • Stage IIIB: extension to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)

  • Stage IIIC: involvement of pelvic and/or para-aortic lymph nodes (including micrometastases), irrespective of tumor size and extent (use r and p notations to indicate findings on radiography and pathology, respectively)

    • Stage IIIC1: pelvic lymph node metastasis only

    • Stage IIIC2: para-aortic lymph node metastasis

• Stage IV: carcinoma has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum (bullous edema does not permit assignment of stage IV)

  • Stage IVA: spread to adjacent pelvic organs

  • Stage IVB: spread to distant organs.

Union for International Cancer Control Classification[102]Union for International Cancer Control Classification. UICC and the TNM classification of malignant tumours. June 2021 [internet publication]. https://www.uicc.org/who-we-are/about-uicc/uicc-and-tnm-classification-malignant-tumours

Staging based on clinical examination, and imaging and pathology (where available). Staging corresponds to FIGO classification.

T - primary tumor

• TX primary tumor cannot be assessed

• T0 no evidence of primary tumor

• Tis carcinoma in situ

• T1 tumor confined to the cervix

  • T1a1 invasive carcinoma diagnosed by microscopy, depth of stromal invasion <3 mm

  • T1a2 invasive carcinoma diagnosed by microscopy, depth of stromal invasion >3 mm and <5 mm

  • T1b1 lesion confined to the cervix >5 mm and <2 cm

  • T1b2 lesion confined to the cervix >2 cm and <4 cm

  • T1b3 lesion >4 cm in diameter.

• T2 tumor invades beyond uterus but not to pelvic wall or to lower 3rd of vagina

  • T2a tumor without parametrial invasion

  • T2a1 lesion <4 cm

  • T2a2 lesion >4 cm

  • T2b tumor with parametrial invasion

• T3a tumor involves lower third of vagina

• T3b tumor or extends to pelvic wall or causes hydronephrosis

• T4 tumor invades mucosa of bladder or rectum or extends beyond the true pelvis.

N - regional lymph nodes

• NX regional lymph nodes cannot be assessed

• N0 no regional lymph node metastasis

• N1 regional lymph node metastasis to pelvic lymph nodes only

• N2 regional lymph node metastasis to para aortic lymph nodes with or without positive pelvic lymph nodes.

M - distant metastasis

• M0 no distant metastasis

• M1 distant metastasis.