FIGO (International Federation of Gynecology and Obstetrics) stage is cancer’s stage that describes how far cancer has spread when the patient is being diagnosed for the first time. Staging is based on the results of doctor’s examinations such as palpation, colposcopy, hysteroscopy, and cystoscopy (Kesic, 2006) and it is not based on the results of surgery. Apart from that, blood tests are also taken to determine how far the cancer has spread.Tumor is a term which normally refers to mass.
According to Stephens et al. (2009), there are two ways in which tumors can grow into: a benign or malignant. Benign tumor is a non-cancerous tumor and it usually grows slowly and appears to be under control. The tumor will stop or slows once it reaches a certain size.
However, benign tumors will become a problem if it becomes very large and spread to other body organs. On the other side, malignant tumors are cancerous growth which means it is made up of cancer cells and grows faster compared to benign tumors. Once it harms surrounding tissue, that is when malignant tumor will become dangerous.According to a study conducted by Sevin et al. (1995), the outcome for tumor size is the most complicated to compare with other reports due to different type of measurements used.
There are several clinical measurements widely used which are palpation, ultrasonography, scanning, etc. Pathologic measurement is the other method for measuring the tumor size which incorporates the surface dimension and maximal lateral extension that mostly depends on the individual laboratories’ technique of measuring. Nevertheless, Sedlis et al. (1999) said that measuring tumor diameter using palpation method is said to be more inaccurate than direct measurement of the deepness of the invasion.
15FIGO stages consist of 4 main stages which are then divided into sub-stages (Freeman et al., 2012):Stage I: In this stage, the cancer has been strictly confined to the cervix, but it does not yet reach outside the uterus.Stage IA: The cancer can only be identified under a microscope since it is still small.
Stage IA1: The cancer is less than 3mm in depth and lower than 7mm in diameter.Stage IA2: Size of the cancer is more than 3mm, but it is not larger than 5mm in depth and the diameter is not wider than 7mm.Stage IB: At this stage, biopsy on the visible wound is compulsory to confirm the diagnosis of cervical cancer.Stage IB1: The cancer is visible but it is no greater than 4cm in size.Stage IB2: Size of the cancer is larger than 4cm.Stage II: The cancer has spread upon the cervix but not yet spread into pelvic walls. It has also spread to the vagina but not to the lower part.
Stage IIA: No sign of parametrial involvement but it may have spread up to the upper part of the vagina.Stage IIB: A sign of parametrial involvement but the cancer does not spread into pelvic sidewall.Stage III: The cancer has extended into the lower third of the vagina and also has extended into the pelvic sidewall. It may block the uterus. A case of non-functioning kidney is an example of Stage III cancer.Stage IIIA: A cancer involvement in the lower third of vagina but not into the pelvic sidewall.
Stage IIIB: The cancer extends into the pelvic sidewall and/or has blocked one or both utterers causing hydronephrosis (kidney problems) or non-functioning kidney.16Stage IV: Cancer that has extends beyond pelvis and spread to nearby organs or other parts of body.Stage IVA: Cancer spread to bladder or rectum.Stage IVB: Cancer spread to distant organs such as lung, liver and bone.In FIGO staging system, parametrial invasion is regarded to have larger prognostic significance than the tumor volume.
This statement is considered to be accurate only if the patients were treated with primary surgery. In any given cases, magnetic resonance imaging (MRI) is useful in detecting parametrial invasion if the patient selected for surgical treatment have an advanced cervical cancer. (Narayan & Lin, 2015).The treatment of a patient with cervical cancer varies depending on the stage of his or her cancer. It is safe to say that the higher the stage of the cancer, the more complex is the treatment required. For patients with FIGO stage IB and IIA, radical hysterectomy and bilateral lymphadenectomy would be the normal treatment for them (Sevin et al.
, 1995). Yamakawa et al. (2000) also agreed that patients treated with those two treatments have a good prognosis and high 5-year survival rates. Huertas et al. (2017) stated that the standard therapy used for patients with stage IB2 or more is the chemoradiotherapy which then followed by uterovaginal brachytherapy boost.
However, Jewell et al. (2007) and Rocconi et al. (2005) expressed that, in the context of cost-effective treatments for patients with FIGO stage IB2, radical hysterectomy would be the best solution.
For less advanced stages or size of tumors, surgery is normally suggested to patients (Huertas et al., 2017).For patients with FIGO stage IIB, a safer treatment for them would be radical radiotherapy compared to radical hysterectomy (Chai et al., 2014). Despite that, there is a research that states the prognostic factors in the analysis of series of radical hysterectomies are said to be the depth of cervical stroll invasion, clinical lesion size and patient’s age. It has also been known that the survival of patient after treatment of radical hysterectomy was affected by the status of lymph node (Peters et al., 2000).
Anyhow, Landoni et al. (1997) also confirmed that most patients with cervical cancer at stage IB to17IIA can be successfully treated with radiotherapy treatment. Having said that, wise selection of patients is essential before preparing for the surgery.According to Kesic (2006), when a patient has cancer up to stage IVA, surgery is no longer an option. The patient will only be treated with chemotherapy. However, if the patient is at stage IVB, she will only be offered any treatment that could reduce pain or any discomfort.
She could be offered chemotherapy that could prolong her life but there is no chemotherapeutic approach that can cure any cancer at this advanced stage.Nevertheless, chemotherapy is said to be only limited to patients with repeated or metastatic cervical cancer. Several studies have been made and it was found that the new strategy for advanced cervical cancer which is neoadjuvant chemotherapy has been applied in the last several years.
This method is found to be effective in lessening the tumor volume, healing lymph node involved and thus increasing the survival rate of patients (Yamakawa et al., 2000).