How is vaginal cancer staged?
The FIGO/AJCC system for staging vaginal cancer
Staging is the process of finding out how far the cancer has spread. It’s very important because your treatment options and the outlook for your recovery and survival (prognosis) depend on the stage of your cancer.
Most vaginal cancers are staged using the FIGO (International Federation of Gynecology and Obstetrics) System of Staging combined with the American Joint Committee on Cancer (AJCC) TNM system. This system classifies the diseases in Stages 0 through IV depending on the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M for metastasis). The system described here is the most recent AJCC system, which went into effect January 2010. Any differences between the AJCC system and the FIGO system are explained in the text.
Vaginal cancer is staged clinically, which means that staging doesn’t take into account what is found during surgery, even if more advanced cancer is found.
These systems are not used to stage vaginal melanoma, which is staged like melanoma of the skin. Information about melanoma staging can be found in our document called Melanoma Skin Cancer.
Tumor extent (T)
Tis: Cancer cells are only in the most superficial layer of cells of the vagina without growth into the underlying tissues. This stage is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). It’s not included in the FIGO system.
T1: The cancer is only in the vagina.
T2: The cancer has grown through the vaginal wall, but not as far as the pelvic wall.
T3: The cancer is growing into the pelvic wall.
T4: The cancer is growing into the bladder or rectum or is growing out of the pelvis.
Lymph node spread of cancer (N)
N0: The cancer has not spread to lymph nodes
N1: The cancer has spread to lymph nodes in the pelvis or groin (inguinal region)
Distant spread of cancer (M)
M0: The cancer has not spread to distant sites
M1: The cancer has spread to distant sites.
Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.
Stage 0 (Tis, N0, M0): In this stage, cancer cells are only in the top layer of cells lining the vagina (the epithelium) and have not grown into the deeper layers of the vagina. Cancers of this stage cannot spread to other parts of the body. Stage 0 vaginal cancer is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). This stage is not included in the FIGO system.
Stage I (T1, N0, M0): The cancer has grown through the top layer of cells but it has not grown out of the vagina and into nearby structures (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage II (T2, N0, M0): The cancer has spread to the connective tissues next to the vagina but has not spread to the wall of the pelvis or to other organs nearby (T2). (The pelvis is the internal cavity that contains the internal female reproductive organs, rectum, bladder, and parts of the large intestine.) It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage III: Either of the following:
T3, any N, M0: The cancer has spread to the wall of the pelvis (T3). It may (or may not) have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).
T1 or T2, N1, M0: The cancer is in the vagina (T1) and it may have grown into the connective tissue nearby (T2). It has spread to lymph nodes nearby (N1), but has not spread to distant sites (M0).
Stage IVA (T4, Any N, M0): The cancer has grown out of the vagina to organs nearby (such as the bladder or rectum) (T4). It may or may not have spread to lymph nodes (any N). It has not spread to distant sites (M0).
Stage IVB (Any T, Any N, M1): Cancer has spread to distant organs such as the lungs (M1).
Last Medical Review: 06/17/2014
Last Revised: 01/12/2015