The 4 Stages of Cervical Cancer

Cervical cancer is cancer that starts in the cervix. The cervix is a small, hollow tube that connects the uterus to the vagina. Cervical cancer is less common in the United States than it once was. Around 0.6% of people assigned female at birth will get cervical cancer during their lifetime. Of course, that’s small comfort for anyone with this diagnosis.

People are often diagnosed with this condition after an abnormal Pap smear indicates cancerous changes in the cervix. Precancerous cells in the cervix (carcinoma in situ) are sometimes referred to as stage 0. Stage 0 is not technically cervical cancer, but it is a serious precancer that requires treatment so it won't become cancer.

If you are diagnosed with cervical cancer, your doctor will run tests to determine what stage the cancer is in. This helps determine the best treatments for you, and your potential prognosis.

Cervical cancer stages are based upon the International Federation of Gynecology and Obstetrics (FIGO) staging system. Cervical cancer stages range from 1 to 4. These stages are categorized by the amount of cancer in the cervix and the spread of cancer outside the cervix.

When diagnosed early, the cervical cancer survival rate is high. This article will discuss treatments, symptoms, and prognosis for each cervical cancer stage.

Stage 1

Stage 1 is localized cancer that has not spread outside of the cervix into lymph nodes or other organs. In this stage, the cancer cells have grown and spread from the surface of the cervix into deeper tissues within the cervix.

People with stage 1 cervical cancer usually have no symptoms. Once diagnosed, stage 1 cervical cancer is highly treatable, and has a good prognosis. The five-year relative survival rate for cervical cancer at this stage is around 92%.

Stage 1 is further classified into stage 1A and stage 1B.

Stage 1A

Stage 1A cancer may be indicated as:

• Stage 1A1: The cancer is less than 3 millimeters (mm) deep and can only be seen under a microscope.
• Stage 1A2: The cancer is between 3 mm and 5 mm. It can only be seen under a microscope.

Before treatment, you and your doctor should discuss if you wish to get pregnant in the future. Stage 1 cervical cancer treatments vary, based on your desire to maintain fertility. Treatment will also be determined by any spread of cancerous cells into the blood, lymphatic vessels, or nearby tissues.

At this stage, localized cancer is usually treated with a cone biopsy (conization) in people who wish to preserve fertility. During this outpatient surgical procedure, a cone-shaped portion of tissue will be removed from the cervix.

If the tissue at the edges of the cone is free from cancer cells, no additional treatment will be needed. You will, however, be watched closely for any potential return of cancer.

Cancer that has spread into the blood or lymph vessels will require removal of the pelvic lymph nodes and, in some instances, a radical trachelectomy. Radical trachelectomy is the removal of most of the cervix, plus the upper vagina. Your uterus will be left intact. Neither of these procedures affects fertility potential.

If you’re sure you don’t wish to pursue pregnancy in the future, a simple hysterectomy may be done instead. In a simple hysterectomy, only the uterus and cervix are removed. Simple hysterectomy is only recommended if the cancer hasn’t spread into the blood or lymph vessels.

If spread has occurred, a radical hysterectomy (uterus, cervix, upper part of the vagina, and supporting tissues are removed) coupled with the removal of the pelvic lymph nodes may be recommended.

In some instances, external beam radiation (high-energy X-rays are aimed at your cancer), followed by brachytherapy (internal radiation), may be done instead of surgery. If the cancer has spread into nearby tissues or lymph nodes, your doctor may recommend chemotherapy (treatment with medications that attack fast-growing cells) in addition to radiation.

Stage 1B

Stage 1B cervical cancer may be indicated as:

• Stage 1B1: The cancer is larger than 5 mm but not more than 2 centimeters (cm) The tumor has grown large enough to be seen without a microscope.
  
• Stage 1B2: The tumor is between 2 and 4 centimeters in size.
• Stage 1B3: The tumor is at least 4 cm in size or larger.

During Stage 1B, your desire to retain fertility potential is taken into account. If you wish to remain fertile, treatment typically consists of a radical trachelectomy, plus surgery to remove lymph nodes from the pelvis (pelvic lymph node dissection).

In some instances, removal of the para-aortic lymph nodes may also be recommended. Para-aortic lymph nodes are located near the aorta. The aorta is the main artery that carries blood from your heart to the rest of your body. 

If maintaining fertility is not a concern, your doctor may recommend radical hysterectomy plus pelvic lymph node removal.

Chemotherapy plus external radiation is usually recommended if the cancer has spread to the tissues next to the uterus, or into nearby lymph nodes. Brachytherapy may be added to your treatment protocol following chemo and radiation.

If you don't want surgery, or aren't strong or healthy enough for it, chemotherapy plus radiation may be used as an alternative treatment.

Stage 1B3 may be treated by chemoradiation first, followed by a hysterectomy.

Stage 2

Stage 2 cervical cancer is cancer that has spread outside the cervix and uterus. Stage 2 cervical cancer has not spread into the lymph nodes, pelvic walls, or lower part of the vagina. It has also not spread to distant organs or areas of your body. 

Stage 2 cervical cancer is further categorized as:

• Stage 2A: Spread is still limited to the cervix. Cancer has not spread into the parametria (tissues around the vagina and cervix).
• Stage 2A1: The tumor is smaller than 4 cm.
• Stage 2A2: The tumor is larger than 4 cm.
• Stage 2B: Spread has occurred into the parametria.

Stage 2 symptoms may include:

• Bleeding after vaginal intercourse
• Pain during intercourse
• Pelvic pain
• Bleeding after menopause
• Bleeding or spotting between periods
• Menstrual periods that become longer or heavier
• Vaginal discharge that sometimes contains blood

Stage 2 cervical cancer is treatable and curable. The relative five-year survival rate for stage 2 cervical cancer is around 61%.

Stage 2A

Cervical cancer in Stage 2A is often treated with radical hysterectomy, plus pelvic lymph node dissection, and para-aortic lymph node sampling. If the cancer has reached the lymph nodes or nearby tissues, radiation may be recommended after surgery.

Chemotherapy may be used in conjunction with radiation treatment. This is referred to as chemoradiation. In some instances, your doctor may instead recommend radiation, with or without chemotherapy, instead of surgery.

Stage 2A2 may be treated by chemotherapy and radiation first, followed by hysterectomy.

Stage 2B

Stage 2B is cervical cancer that has spread outside of the cervix into the surrounding pelvic tissues, such as the top of the vagina, bladder, or rectum. This stage is referred to as locally advanced cervical cancer.

Cervical cancer at this stage is usually treated with chemoradiation (chemotherapy and radiation treatment combined). External beam radiation and brachytherapy may both be used.

Stage 3

Stage 3 cervical cancer is cancer that has spread into the lower vagina or pelvic walls. It may or may not have spread into nearby lymph nodes. It has not spread to distant organs or areas of the body.

Stage 3 cervical cancer is further categorized into these groups:

• Stage 3A: The cancer has spread to the lower vagina, but not the pelvic walls.
• Stage 3B: The cancer has spread to the pelvic walls. The tumor or tumors may also be large enough to cause hydronephrosis (excess fluid in the kidney due to backup of urine).
• Stage 3C1: The tumor is of any size and has spread into the pelvic lymph nodes.
• Stage 3C2: The tumor is of any size and has spread to the para-aortic lymph nodes.

If you have stage 3 cervical cancer, the tumor or tumors may be large enough to block the tubes that carry urine from your kidneys to your bladder (ureters). This condition is called hydronephrosis. 

Symptoms of stage 3 cervical cancer include:  

• Difficulty urinating or moving your bowels
• Swollen legs
• Painful vaginal sex
• Blood in urine
• Unexplained weight loss
• Back pain
  

Since spread has occurred, the prognosis for stage 3 cervical cancer is lower than that for stages 1 and 2. Stage 3A has an approximate five-year survival rate of 35%. Stage 3B is slightly lower, at 32%.

It's important to remember that relative five-year survival rates are estimates, not prophecies. Many people live far longer than the numbers indicate. These estimates are also based on the experiences of people who had this condition at least five years ago. They don’t take newer treatments or data from recent clinical trials into account.

Stage 3A

In this stage, the cancer has spread into the lower third of the vagina. It has not spread into the walls of the pelvis.

Stage 3A cervical cancer is treated with chemoradiation. The radiation used will be a combination of external beam radiation plus brachytherapy.

Stage 3B

In this stage, the cancer has spread into the pelvic wall.

The tumor or tumors may also be large enough to cause problems with the kidneys, including hydronephrosis. Stage3B cervical cancer may have tumors that block one or both ureter tubes.

Stage 3B cervical cancer is treated with chemoradiation.

Stage 3C

Stage 3C is cervical cancer of any size within the pelvis. It has not spread to distant areas of the body or into other internal organs. Stage 3C cancer that has spread into the lymph nodes is further categorized into stage 3C1 and stage 3C2.

• In stage 3C1, the tumor is of any size and has spread into the pelvic lymph nodes.
• In stage 3C2, the tumor is of any size and has spread to the para-aortic lymph nodes within the abdomen.

Stage 3C cervical cancer is typically treated with chemoradiation.

Stage 4

Stage 4 is the most advanced cervical cancer stage. Recurrent cervical cancer is typically included in this stage. In stage 4, cancerous cells have metastasized (spread) to nearby organs or other areas of the body.

Stage 4 cervical cancer may spread to nearby organs such as the bladder or rectum. It may also spread to distant organs and parts of the body, such as the liver, lungs, or bone.

Stage 4 cervical cancer is further categorized as:  

• Stage 4A: Cancer has spread outside of the pelvis, or has spread to nearby organs like the bladder or rectum.
• Stage 4B: Cancer has spread to distant organs or to distant lymph nodes.

Stage 4 symptoms can include:

• Fatigue or exhaustion
• Weakness
• Dizziness
• Bone pain or fractures
• Vaginal fistula (a hole connecting the vagina and the rectum)
• Trouble breathing, or shortness of breath
• Spitting up blood

The five-year relative survival rate for stage 4 cervical cancer is around 17%. As with any cancer, it’s important to remember that these numbers are estimates. Many people live and thrive for significantly longer periods of time.

Stage 4A

Chemoradiation is the main treatment for cancer at this stage. Radiation therapy will be both external beam radiation, and brachytherapy.

Stage 4B

Cancer at this stage is not usually considered curable. Treatments that may be tried include radiation, with or without chemotherapy. Targeted therapy and immunotherapy may also be used.

Targeted therapy is a type of cancer treatment that targets the proteins in and on cancer cells that control how they grow, spread, and divide. Immunotherapy is a type of cancer treatment that supports your immune system to better fight cancer.

In some instances, you may wish your treatment at this time to center on palliative care. Palliative care refers to treatments that make you feel comfortable and pain free while you’re living with your disease.

Palliative care treatments include symptom reduction and control. For late-stage cervical cancer, radiation can be used to slow cancer growth, reduce pain, and eliminate bleeding.

Living With Cervical Cancer

Some people diagnosed with cervical cancer will get a clean bill of health after treatment ends. Others will continue to have cancer for the rest of their lives. Either way, you’ll need to be vigilant about checkups and tests that your doctor recommends.

You’ll also need to keep an eye on any new symptoms you notice. Communicating with your oncologist and other members of your medical team can help ensure that you receive swift treatment as needed.

Cervical cancer treatments come with side effects. Based on the treatments you had, these can include nausea, fatigue, and increased bruising. You may go into early menopause or have irregular menstruation.

Communicating with your medical team about side effects can provide information and, in some instances, treatments that will ease your symptoms.

Currently, there isn’t a large body of research linking healthy habits to a reduction in cervical cancer recurrence.  What is known is that smoking can play a role in increasing cervical cancer risk. If you smoke, this is a very good time to stop.

Proactive self-care that includes healthy eating and physical movement may not be a cure-all, but it can boost your mood and help you feel stronger. Anything that supports your ability to manage stress should be included in your self-care plan. This can be anything from practicing yoga with friends, to reading an absorbing whodunnit.

Some people isolate in times of trouble. If that sounds a lot like you, consider trying something new. Cancer support groups, both in person and online, can provide access to people who understand what you’re going through, and can offer powerful support.

The American Cancer Society’s Cancer Survivors Network is a good place to start. If that doesn’t feel like a fit, reach out to a friend or family member often just to chat, or even to vent.

Summary

Cervical cancer is cancer that starts in the cervix. The cervix is a hollow organ that connects the uterus to the vagina. Cervical cancer is graded by stages from 1 to 4. These stages indicate how much cancer is in the cervix and how much it has spread to distant areas of the body.

When caught early, this cancer has a very high cure rate. Cervical cancer can be treated with radiation, chemotherapy, surgery, and other treatments. People with stage 1 cancer can have treatments that won’t harm their fertility. 

A Word From Verywell

Living with cervical cancer can be stressful, scary, and worrisome. Not only are you dealing with how you feel today, you may also be thinking about tomorrow. Even if this time of your life feels out of control, remember that there are things you can and should control.

These include keeping doctor’s appointments and staying educated about your condition. It also includes taking care of yourself in a loving way. No matter what stage your cancer was diagnosed in, there is always room for hope, life’s simplest pleasures, and joy.