Cervix Carcinoma Stage II
Stage II cervical cancer means the disease has begun to grow beyond the cervix into nearby tissues, but it has not yet reached the pelvic wall or the lower part of the vagina. Understanding what this stage means and what treatment options are available can help you work with your medical team to make informed decisions about your care.
Table of contents
What is Stage II Cervical Cancer?
Stage II cervical cancer describes cancer that has spread from the cervix (the neck of the womb) into surrounding tissues. The cervix connects the uterus to the vagina. At this stage, the cancer has moved beyond where it started, but it has not yet grown into certain important structures[1][2].
The cancer has not reached the pelvic wall, which is made up of the muscles and ligaments that line the area between the hip bones. It also has not spread to the lower part of the vagina[1][2].
Doctors use a system created by the International Federation of Gynecology and Obstetrics (FIGO) to classify cervical cancer into stages numbered 1 to 4. Knowing the stage helps your doctor decide which treatment will work best for you[1][2].
Understanding the Substages
Stage II cervical cancer is divided into two substages based on where the cancer has spread[1][2].
Stage IIA
In stage IIA, the cancer has spread from the cervix down into the upper two-thirds of the vagina. It has not spread to the tissue around the uterus (the womb)[1][2].
Stage IIA is further divided based on the size of the tumor. Stage IIA1 means the tumor is 4 centimeters or smaller. Stage IIA2 means the tumor is larger than 4 centimeters[1][2].
Stage IIB
In stage IIB, the cancer has spread from the cervix into the tissue around the uterus. This tissue is called the parametria[1][2].
Treatment Options
The stage of your cancer is one of the most important factors your doctor considers when recommending treatment. Other factors include the type of cancer cells, where exactly the cancer is located, your overall health, and your personal preferences[1][5].
Combined Chemotherapy and Radiotherapy
The main treatment for stage II cervical cancer is a combination of chemotherapy (anti-cancer drugs) and radiotherapy (treatment with high-energy x-rays). This combination is called chemoradiotherapy[1][5][12].
With this treatment, you receive chemotherapy at the same time as radiotherapy. The chemotherapy makes the radiotherapy more effective at killing cancer cells. It may also destroy cancer cells on its own[5][12].
You typically have external radiotherapy for 5 days every week for around 5 to 7 weeks. You also have internal radiotherapy, called brachytherapy, which involves placing radioactive material directly into and near the cervix. This allows a high dose of radiation to reach the cancer while reducing the amount that reaches surrounding healthy tissues. Brachytherapy is usually given after external radiotherapy or chemoradiotherapy[1][5][12].
The chemotherapy drug most commonly used is cisplatin, either alone or combined with another drug called 5-fluorouracil (5-FU). If cisplatin is used alone, it is usually given once each week during the radiotherapy schedule. If cisplatin plus 5-FU is used, it is usually given every 4 weeks during radiotherapy[5][12].
You might also have a boost of radiotherapy if there is a risk of cancer cells in the lymph nodes (small bean-shaped organs that are part of the body’s defense system) in your pelvis[1].
Surgery
You may be offered surgery for stage II cervical cancer. The type of surgery depends on several factors, including your age, the exact stage of your cancer, and whether you want to become pregnant in the future[5][12].
For stage IIA cervical cancer, a radical hysterectomy (surgery to remove the uterus, cervix, and surrounding tissue) with removal of lymph nodes in the pelvis may be offered. This may be an option for women who do not want to become pregnant in the future. Radiation or chemoradiation may be given after a radical hysterectomy[5][12].
For stage IIB cervical cancer, you may have a lymph node dissection to remove the pelvic lymph nodes. This is because there is a risk the cancer may have spread from the cervix to these nearby lymph nodes. This surgery is followed by radiation therapy alone or chemoradiation[5][12].
Some people might have a radical hysterectomy followed by chemoradiotherapy, but this is not a standard treatment. This combination of treatments is generally not advised[1][11].
Radiation Therapy
You may be offered radiation therapy for stage II cervical cancer if you cannot have surgery or choose not to have surgery. It is also used after surgery in certain situations, such as when there are cancer cells in or close to the edges of the removed tissue, in blood vessels or lymph vessels in the removed tissue, or in lymph nodes[5][12].
External radiation therapy may be given alone or with brachytherapy. Women who have radiation therapy will often have both types. In most cases, radiation therapy is given with chemotherapy, but in some cases it may be used alone[5][12].
Clinical Trials
Your doctor may talk to you about clinical trials. These are research studies that test new ways to prevent, find, and treat cancer. Participating in a clinical trial may give you access to new treatments before they become widely available[5][12][13].