Stage 4

Stage 4 means the cancer has spread to the bladder or back passage (rectum) or further away. The main treatments are surgery, radiotherapy, chemotherapy or a combination of these treatments. Or you might have treatment to control symptoms. 

What is it?

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need.

Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer. There are 4 stages, numbered 1 to 4. 

Stage 4 means the cancer has spread to parts of the body outside the cervix and womb. It can be divided into stage 4A and stage 4B.

Stage 4A

Stage 4A is when the cancer has spread to nearby organs such as the bladder or back passage (rectum).

Diagram showing stage 4A cervical cancer

Stage 4B

Stage 4B is when the cancer has spread to organs further away, such as the lungs. Your doctor might call this secondary or metastatic cancer.

Diagram showing stage 4B cervical cancer


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

For stage 4 cervical cancer you might have treatment with: 

  • surgery 
  • radiotherapy
  • chemotherapy
  • targeted cancer drug

You might have a combination of these treatments.

Some women may choose just to have treatment to control symptoms. 

Treatment for cancer that has spread to nearby organs

You usually have treatment with a combination of radiotherapy and chemotherapy (chemoradiotherapy) for stage 4A cervical cancer.

With this treatment, you have daily external radiotherapy for 5 days every week, for around 5 weeks. You also have a boost of internal radiotherapy (brachytherapy) at the end of your course.

During your course of radiotherapy, you also have chemotherapy once a week or once every 2 or 3 weeks. This depends on the chemotherapy drugs you have.

Treatment for cancer that has come back

Sometimes cervical cancer can come back after treatment. It may come back near to the area where the cancer first started (local recurrence). Or in another part of the body (secondary or metastatic cancer).

The treatment you have depends on:

  • where the cancer is
  • what treatment you had before
  • your general health
  • your wishes

Your doctor will talk to you about what the treatment options are and what the aim of treatment is.

You might have surgery if the cancer hasn't spread too far. The operation might mean removing your womb and cervix (hysterectomy), the nearby lymph nodes and any part of the bladder or bowel that might be affected. This is a big operation and isn’t suitable for everyone.

If you've had radiotherapy before to treat cervical cancer, you might not be able to have any more to that area of the body. There is a maximum amount of radiotherapy normal body tissues can take.

You might be given chemotherapy with another drug called bevacizumab. 

Other stages

  • Cancer: Principles and Practice of Oncology (11th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2019

  • Cancer and its Management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

  • Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    C Marth and others 
    Annals of Oncology, 2017. Volume 28, Supplement 4

  • 2018 FIGO Staging System for Cervical cancer: Summary and comparison with 2009 FIGO
    Staging System

    N.Singh, B. Rous and R.Ganesan

    The British Association of Gynaecological Pathologists. 2018 

Last reviewed: 
23 Jul 2020
Next review due: 
23 Jul 2023