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The following is the cervical cancer staging system as designated by the Federation Internationale de Gynecologie et d'Obstetrique (FIGO) System of Staging. [37]

Stage I

Stage I is carcinoma strictly confined to the cervix; extension to the uterine corpus should be disregarded.

Stage IA: Invasive cancer identified only microscopically. All gross lesions even with superficial invasion are stage IB cancers. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm* and no wider than 7 mm. [Note: *The depth of invasion should be ≤5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space involvement, either venous or lymphatic, should not alter the staging.]
- Stage IA1: Measured invasion of the stroma ≤3 mm in depth and ≤7 mm diameter
- Stage IA2: Measured invasion of stroma >3 mm but ≤5 mm in depth and ≤7 mm in diameter
Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than stage IA
- Stage IB1: Clinical lesions ≤4 cm in size
- Stage IB2: Clinical lesions >4 cm in size

Stage II

Stage II is carcinoma that extends beyond the cervix but has not extended onto the pelvic wall. The carcinoma involves the vagina but not as far as the lower third section.

Stage IIA: No obvious parametrial involvement. Involvement of as much as the upper two thirds of the vagina
Stage IIB: Obvious parametrial involvement but not onto the pelvic sidewall

Stage III

Stage III is carcinoma that has extended onto the pelvic sidewall and/or involves the lower third of the vagina. On rectal examination, there is no cancer-free space between the tumor and the pelvic sidewall. All cases with a hydronephrosis or nonfunctioning kidney should be included, unless they are known to be due to other causes.

Stage IIIA: No extension onto the pelvic sidewall but involvement of the lower third of the vagina
Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or nonfunctioning kidney

Stage IV

Stage IV is carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.

Stage IVA: Spread of the tumor onto adjacent pelvic organs
Stage IVB: Spread to distant organs

Survival by Stage

The information below relates to the chances a woman will live 5 years after treatment for the various stages of cervical cancer. They also include women who die from other causes. The numbers come from women treated more than 10 years ago. [35]

Important Safety Information

Contraindications

Hycamtin is contraindicated in patients who have a history of hypersensitivity reactions to topotecan or to any of its ingredients. Hycamtin should not be used in patients who are pregnant or breast-feeding, or those with severe bone marrow depression.

Warnings

Hycamtin should be used only in patients with adequate bone marrow reserves, including baseline neutrophil counts of at least 1,500 cells/mm³ and platelet counts of at least 100,000/mm³. Frequent monitoring of blood counts should be instituted during treatment with Hycamtin.

Patients should not be treated with subsequent courses of Hycamtin until neutrophils recover to >1,000 cells/mm³, platelets recover to >100,000 cells/mm³, and hemoglobin levels recover to 9.0 g/dL (with transfusion if necessary).

Hycamtin may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant during therapy with Hycamtin.

Drug Interactions

Concomitant administration of G-CSF can prolong the duration of neutropenia, so if G-CSF is to be used, it should not be initiated until day 6 of the course of therapy, 24 hours after completion of treatment with Hycamtin.

Myelosuppression was more severe when Hycamtin was given in combination with cisplatin in phase I studies. In a reported study on concomitant administration of cisplatin 50 mg/m² and Hycamtin at a dose of 1.25 mg/m²/day x 5 days, 1 of 3 patients had severe neutropenia for 12 days, and a second patient died with neutropenic sepsis. There are no adequate data to define a safe and effective regimen for Hycamtin and cisplatin in combination.

Adverse Events

Frequently reported nonhematologic adverse events associated with use of Hycamtin included nausea (64%), vomiting (45%), diarrhea (32%), alopecia (49%), fatigue (29%), and dyspnea (22%). Most nonhematologic toxicities were grade 1 or 2.

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