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Cervical Carcinoma Cellular Classification
Squamous cell (epidermoid) cervical carcinoma comprises approximately 90%, and cervical adenocarcinoma comprises approximately 10% of cervical cancers. Adenosquamous and cervical small cell carcinomas are relatively rare. Primary sarcomas of the cervix have been described occasionally, and malignant lymphomas of the cervix, both primary and secondary, have also been reported.
Cervical Carcinoma Stage
Cervical carcinoma has its origins at the squamous-columnar junction whether in the endocervical canal or on the portio of the cervix. The precursor lesion is dysplasia or cervical carcinoma in situ (cervical intraepithelial neoplasia (CIN)), which can subsequently become invasive cervical cancer. This process can be quite slow. Longitudinal studies have shown that in untreated patients with in situ cervical cancer, 30% to 70% will develop invasive cervical carcinoma over a period of 10 to 12 years. However, in about 10% of patients, lesions can progress from in cervical carcinoma in situ to invasive cervical carcinoma in a period of under 1 year. As it becomes invasive, the tumor breaks through the basement membrane and invades the cervical stroma. Extension of the tumor in the cervix may ultimately manifest as ulceration, exophytic tumor, or extensive infiltration of underlying tissue including bladder or rectum.
In addition to local invasion, carcinoma of the cervix can spread via the regional lymphatics or bloodstream. Tumor dissemination is generally a function of the extent and invasiveness of the local lesion. While cancer of the cervix generally progresses in an orderly manner, occasionally a small tumor with distant metastasis is seen. For this reason, patients must be carefully evaluated for metastatic disease.
FIGO staging
Stage I
Stage I is Cervical carcinoma strictly confined to the cervix; extension to the uterine corpus should be disregarded.
Stage 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 mm* and no wider than 7 mm. [Note: *The depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space involvement, either venous or lymphatic, should not alter the staging.]
Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.
Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.
Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than stage IA.
Stage IB1: Clinical lesions no greater than 4 cm in size.
Stage IB2: Clinical lesions greater than 4 cm in size.
Stage II
Stage II is Cervical carcinoma that extends beyond the cervix but has not extended onto the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third.
Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two thirds of the vagina.
Stage IIB: Obvious parametrial involvement, but not onto the pelvic sidewall.
Stage III
Stage III is Cervical carcinoma that has extended onto the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumor and the pelvic sidewall. The tumor involves the lower third of the vagina. All cases with a hydronephrosis or nonfunctioning kidney should be included, unless they are known to be due to other causes.
Stage IIIA: No extension onto the pelvic sidewall but involvement of the lower third of the vagina.
Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or nonfunctioning kidney.
Stage IV
Stage IV is Cervical carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
Stage IVA: Spread of the tumor onto adjacent pelvic organs.
Stage IVB: Spread to distant organs.
National Cancer Institute
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