Stage of Cervical Cancer
What are the stages of cervical cancer?
Staging of a cancer is done to indicate the extent and spread of the disease. Staging helps in determining the type of treatment best suited for that particular patient as well as the prognosis. Clinical assessment of a patient at the time of diagnosis forms the basis of staging a case of cervical cancer.
Besides physical examination, certain investigations may help to arrive at a conclusion about the stage of the disease. These investigations include a :
- Cervical curettage
- Chest x-ray
- X-ray of the bones
- CT scan and MRI
The cervical cancer stages are as follows :
It is also known as carcinoma in situ, cervical intraepithelial neoplasia (CIN), dysplasia, or squamous intraepithelial lesion (SIL). This is the pre-cancerous stage of cervical cancer. If treated at this stage, further progression into cervical cancer can be prevented.
The appearance of the cervical cells under the microscope can help to detect early warning signs of cervical cancer.
Cervical dyskaryosis or dysplasia is the abnormal appearance of the cervical cells as seen under the microscope. Dysplasia does not mean that a woman has cervical cancer. It only indicates that the abnormal cells may be potentially cancerous. Further management will depend upon the extent of cell abnormality.
- Mild or borderline dyskaryosis (also known as CIN 1) means that there are only very minor cell abnormalities detected. This stage usually regresses on its own without any treatment but two repeat pap tests at 6 month intervals are usually advised. If normal, the patient need only have regular pap tests like any other woman. If borderline changes are detected on repeat pap tests, the next step will be to have a colposcopy, which is viewing the cervix by means of an instrument (colposcope) placed near the vaginal opening.
- Moderate dyskaryosis also known as CIN 2.
- Severe dyskaryosis also known as CIN 3.
Moderate and severe dyskaryosis means that certain cell abnormalities are there but not to the extent of being cancerous. A colposcopy is indicated in these cases.
Invasive carcinoma is when the cancer has invaded the deeper layers of the cervix, but has not spread any further. It is therefore limited to the cervix.
The cancer has spread beyond the uterus to the nearby tissues and the upper part of the vagina, but it has not reached the pelvic wall or lower third of the vagina.
The cancer has spread to the pelvic wall or the lower third of the vagina, and/or resulting in a non-functioning kidney or hydronephrosis due to involvement of the ureter.
The cancer has spread to the bladder or bowel mucosa, or has metastasized to distant organs such as the lungs and liver.
The cancer may come back again after treatment following a cancer-free (remission) period. Recurrence usually occurs within 2 years of treatment. The cancer may appear in the cervix again or may develop in some other part of the body.
Prognosis of Cervical Cancer
What is the survival rate of cervical cancer?
Most cervical cancers are slow growing. The change from pre-cancerous to cancerous lesions may take years to develop. As a result, early detection is the key to good prognosis of cervical cancer.
The 5-year survival rate of cervical cancer patients is the number or percentage of such patients who are alive at least 5 years after detection of cancer. Early treatment may mean that many women will live much longer than 5 years.
The prognosis or outcome of cervical cancer will depend upon the stage at which the cancer was detected. Obviously, a woman with stage 1 cervical cancer, where the cancer is limited to the cervix, will definitely have a much better prognosis than stages 2, 3, or 4 where the cancer has spread to nearby or distant sites. The 5-year survival rate of women with cervical cancer detected in stage 1 may be as high as 80% to 90%. This significantly drops with the progression of cancer. The 5-year survival rate in stage 4 cervical cancer may only be 15% or lower.
Carcinoma in situ is totally curable.
Other factors involved in the prognosis are :
- The age of the patient.
- The general health status of the patient at the time of diagnosis.
- The type of treatment undertaken and the response to it.
- Treatment in the early stage can offer a good chance of cure. Sometimes, particularly in the late stages of the disease, a cure may not be possible. Treatment can either help to slow down the course of the disease or it can only help to relieve symptoms (palliative treatment).
- If it is a recurrent cancer, the prognosis may not be so good.
- If it is a metastatic cancer, the prognosis will depend upon the primary cancer but is also not very good.
- Cervical cancer in a woman with a weakened immune system will have a grave prognosis.
- Size of the tumor and type of cervical cancer are other factors that will affect the outlook.