Free Cervical cancer staging Calculator | obstetrics Clinical Decision Support

How it Works

Stage I – Confined to Cervix

Substage	Definition
IA1	Microscopic stromal invasion ≤3 mm depth (horizontal spread no longer considered)
IA2	Microscopic stromal invasion >3 mm and ≤5 mm depth
IB1	Invasive carcinoma >5 mm depth AND ≤2 cm in greatest dimension
IB2	>2 cm and ≤4 cm in greatest dimension
IB3	>4 cm in greatest dimension

Stage II – Beyond Uterus, Not to Pelvic Wall/Lower 1/3 Vagina

Substage	Definition
IIA1	Upper 2/3 vaginal involvement, no parametrial invasion, ≤4 cm tumor
IIA2	Upper 2/3 vaginal involvement, no parametrial invasion, >4 cm tumor
IIB	Parametrial invasion (not reaching pelvic wall)

Stage III – Lower Vagina, Pelvic Wall, or Lymph Nodes

Substage	Definition
IIIA	Tumor involves lower 1/3 of vagina, no extension to pelvic wall
IIIB	Tumor extends to pelvic wall and/or causes hydronephrosis/non‑functioning kidney
IIIC1	Pelvic lymph node metastasis (any primary tumor size/extent) – use notation r (imaging) or p (pathology)
IIIC2	Para‑aortic lymph node metastasis – use notation r or p

Stage IV – Adjacent Organs or Distant Metastasis

Substage	Definition
IVA	Tumor invades bladder or rectal mucosa (biopsy‑proven); bullous edema alone does not qualify
IVB	Distant metastasis (e.g., lung, liver, bone, supraclavicular/mediastinal nodes, peritoneal spread)

Clinical Pearls

Critical Rules for Lymph Node (IIIC) Staging

Any lymph node metastasis (pelvic or para‑aortic) automatically assigns stage IIIC, regardless of primary tumor size or local extent.

Notation is mandatory: IIIC1r (pelvic nodes on imaging), IIIC1p (pelvic nodes on pathology), IIIC2r, IIIC2p.

Micrometastases (0.2‑2 mm) qualify as IIIC; isolated tumor cells (≤0.2 mm) do not change stage but must be recorded.

Pathological findings (p) supersede radiological findings (r) if both are available.

Key Updates from 2009 to 2018

Horizontal spread removed from stage IA criteria (no longer required to measure width).

Stage IB divided into three substages (IB1, IB2, IB3) based on exact tumor size – this better predicts need for adjuvant therapy.

Hydronephrosis alone (without pelvic wall fixation) moved from stage IIIA to IIIB.

Imaging and pathology are now permitted to change stage assignment – a major departure from prior clinical‑only rules.

Next Steps

Treatment Implications (General Guidelines)

01

IA1‑IB1 (≤2 cm): Fertility‑sparing trachelectomy or simple/radical hysterectomy with pelvic lymph node dissection.

02

IB2 (2‑4 cm): Radical hysterectomy + pelvic lymphadenectomy OR primary chemoradiation (controversial, depends on institutional expertise).

03

IB3 (≥4 cm) and IIA2 (≥4 cm): Primary concurrent cisplatin‑based chemoradiation (preferred due to high risk of adjuvant therapy).

04

IIB‑IVA: Definitive chemoradiation (cisplatin 40 mg/m² weekly) ± brachytherapy.

05

IVB: Systemic therapy (carboplatin + paclitaxel + bevacizumab + pembrolizumab if PD‑L1 positive).

Prognostic Impact (from Bhatla et al., 2021)

Retrospective analyses show that the 2018 staging better discriminates survival than the 2009 system. For example, 5‑year overall survival for stage IB1, IB2, and IB3 is 97%, 92%, and 83% respectively. Stage IIIC1 has intermediate prognosis between IIIB and IVA, emphasizing the need to record tumor size even in node‑positive cases (currently not captured).

The Evidence

Primary Sources

Revised FIGO staging for carcinoma of the cervix uteri.

Bhatla N et al. • Int J Gynaecol Obstet.. 2019;The official 2018 revision document that introduced stage IIIC, removed horizontal spread from IA, and permitted imaging/pathology for staging.

Implications of the revised cervical cancer FIGO staging system.

Bhatla N et al. • Indian J Med Res.. 2021;Comprehensive review of the 2018 changes from the perspectives of gynecologic oncologists, radiologists, and pathologists.

View Source

Cervical Cancer Staging. Medscape.

Boardman CH et al. • . 2026;Current TNM and FIGO classification tables with clinical context.

View Source

Origins & History

FIGO

The International Federation of Gynecology and Obstetrics (FIGO) Committee on Gynecologic Oncology first published a staging system for cervical cancer in 1961. The 2018 revision (effective 2019) is the most substantial update in decades, aligning staging with modern diagnostic tools while maintaining relevance for low‑resource settings.

Cervical Cancer Staging

FIGO Cervical Cancer Staging (2018 Revision)

When to Use

Primary Clinical Uses

2018 Paradigm Shift (Bhatla et al., 2021)

How it Works

Stage I – Confined to Cervix

Stage II – Beyond Uterus, Not to Pelvic Wall/Lower 1/3 Vagina

Stage III – Lower Vagina, Pelvic Wall, or Lymph Nodes

Stage IV – Adjacent Organs or Distant Metastasis

Clinical Pearls

Critical Rules for Lymph Node (IIIC) Staging

Key Updates from 2009 to 2018

Next Steps

Treatment Implications (General Guidelines)

Prognostic Impact (from Bhatla et al., 2021)

The Evidence

Primary Sources

Revised FIGO staging for carcinoma of the cervix uteri.

Implications of the revised cervical cancer FIGO staging system.

Cervical Cancer Staging. Medscape.

Origins & History

FIGO

In Recent Clinical News

Cervical Cancer Staging

FIGO Cervical Cancer Staging (2018 Revision)

When to Use

Primary Clinical Uses

2018 Paradigm Shift (Bhatla et al., 2021)

How it Works

Stage I – Confined to Cervix

Stage II – Beyond Uterus, Not to Pelvic Wall/Lower 1/3 Vagina

Stage III – Lower Vagina, Pelvic Wall, or Lymph Nodes

Stage IV – Adjacent Organs or Distant Metastasis

Clinical Pearls

Critical Rules for Lymph Node (IIIC) Staging

Key Updates from 2009 to 2018

Next Steps

Treatment Implications (General Guidelines)

Prognostic Impact (from Bhatla et al., 2021)

The Evidence

Primary Sources

Revised FIGO staging for carcinoma of the cervix uteri.

Implications of the revised cervical cancer FIGO staging system.

Cervical Cancer Staging. Medscape.

Origins & History

FIGO

In Recent Clinical News