Treatment Guideline Chart
Patients with abnormal Pap smear are referred for colposcopy to screen for presence of cervical cancer.
Colposcopic exam should include inspection of the transformation zone, definition of the extent of the lesion and biopsy of the most abnormal area for tissue diagnosis.
The earliest stages of cervical carcinoma are generally asymptomatic.
Watery vaginal discharge, postcoital or postmenopausal bleeding, intermittent spotting, or abdominal pain may be present and is usually unrecognized by the patient.

Cervical%20cancer%20-%20treatment Diagnosis

Laboratory Tests

  • Complete blood count (CBC) with platelet count
  • Liver function tests (LFTs)
  • Renal function tests
  • Urinalysis

Additional Tests

  • Biomarkers for programmed death-ligand 1 (PD-L1) and microsatellite instability and mismatch repair deficiency (MSI/MMR) in patients with recurrent, progressive, or metastatic disease
  • Cystoscopy and proctoscopy under anesthesia should be reserved for patients in whom there is suspicion of bladder or rectal extension
  • Intravenous pyelogram (IVP)


  • Positron emission tomography (PET)-computed tomography (CT) (PET-CT) scan
    • PET/CT scan may be used to rule out extrapelvic disease, detect persistent disease or recurrences which may respond to curative salvage therapy
    • PET is used to define the nodal volume of coverage, especially in patients who are not surgically staged
  • Magnetic resonance imaging (MRI)
    • Superior to CT in determining tumor extension such as soft tissue and parametrial involvement, and equal to CT for nodal involvement evaluation
    • Used to evaluate extent of local disease, to rule out diseases that are high in the endocervical area and to assist in radiation treatment planning
  • CT scan
  • Transvaginal/transrectal ultrasound with doppler studies
  • Bone scan
  • Chest X-ray


  • Cervical cancer is clinically staged
  • Staging is for comparison purposes only and not as a treatment guide

  • Clinical Findings FIGO Stages TNM Stages
    Cervical carcinoma confined to cervix (extension to uterine corpus should be disregarded) I T1

    - Invasive carcinoma diagnosed only by microscopy, with deepest invasion of ≤5 mm

    IA T1a

    - Stromal invasion ≤3 mm in depth

    IA1 T1a1

    - Stromal invasion >3 mm and ≤5 mm

    IA2 T1a2

    - Invasive carcinoma with deepest invasion >5 mm (>stage IA); lesion is confined to the cervix with size measured by maximum tumor diameter2

    IB T1b

    - Invasive carcinoma with deepest invasion >5 mm and ≤2 cm in greatest dimension

    IB1 T1b1

    - Invasive carcinoma with deepest invasion >2 cm and ≤4 cm in greatest dimension

    IB2 T1b2

    - Invasive carcinoma >4 cm in greatest dimension

    Cervical carcinoma invades beyond the uterus but not to pelvic wall or to lower 3rd of vagina II T2

    - Involves up to the upper 2/3 of vagina; without parametrial invasion

    IIA T2a

    - Invasive carcinoma ≤4 cm in greatest dimension

    IIA1 T2a1

    - Invasive carcinoma >4 cm in greatest dimension

    IIA2 T2a2

    - With parametrial invasion but no extension to pelvic sidewall

    IIB T2b
    Carcinoma extends to pelvic wall and/or involves lower 3rd of vagina and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or para-aortic lymph nodes III T3

    - Carcinoma involves lower 3rd of vagina with no extension to pelvic wall

    IIIA T3a

    - Carcinoma extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney

    IIIB T3b

    - Invades pelvic and/or para-aortic lymph nodes including micrometastases3 irrespective of tumor size and extent and with r and p notations4

                  - Pelvic lymph node metastasis only  IIIC1  
                  - Para-aortic lymph node metastasis  IIIC2  N1
    Carcinoma extends beyond the true pelvis or invades bladder or rectal mucosa. The presence of bullous edema is not sufficient to classify a tumor as stage IV IV T4

    - Adjacent pelvic organs spread present

    IVA  T4

    - Presence of distant metastasis

    IVB M1

1References: Bhatla N, Berek JS, Fredes MC, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-135; National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer. Version 1.2022. NCCN. https://www.nccn.org/. 26 Oct 2021.
2Involvement of lymphatic or vascular spaces will not change the staging and lateral extent of the lesion is no longer considered.
3Isolated tumor cells do not change the stage but presence should be recorded.
4Notation of r (imaging) and p (pathology) is added to indicate the results which are used to allocate the case to stage IIIC.

Editor's Recommendations
Special Reports