Vulvar Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How is vulvar cancer staged?

The FIGO/AJCC system for staging vulvar cancer

The 2 systems used for staging most types of vulvar cancer -- the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM staging system -- are very similar. They both classify vulvar cancer on the basis of 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). The system described below 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.

These systems are not used to stage vulvar melanoma, which is staged like melanoma of the skin. Information about melanoma staging can be found in our document, Melanoma Skin Cancer.

Tumor extent (T)

Tis: The cancer is not growing into the underlying tissues. This stage, also known as carcinoma in situ, is not included in the FIGO system.

T1: The cancer is growing only in the vulva or perineum

  • T1a: The cancer has grown no more than 1 mm into underlying tissue (stroma) and is 2 cm or smaller in size. (about 0.8 inches).
  • T1b: The cancer is either more than 2 cm or it has grown more than 1 mm into underlying tissue (stroma).

T2: The tumor can be any size. The cancer is growing into the anus or the lower third of the vagina or urethra (the tube that drains urine from the bladder). (This is called stage 2/3 in the FIGO system)

T3: The tumor can be any size. The cancer is growing into the upper urethra, bladder or rectum or into the pubic bone. (This is called stage 4 in the FIGO system)

Lymph node spread of cancer (N)

N0: No lymph node spread

N1: The cancer has spread to 1 or 2 lymph nodes in the groin with the following features:

  • N1a: The cancer has spread to 1 or 2 lymph nodes and the areas of cancer spread are both less than 5 mm (about 1/5th of an inch) in size
  • N1b: The cancer has spread to one lymph node and the area of cancer spread is 5 mm or greater

N2: The cancer has spread to groin lymph nodes with the following features:

  • N2a: The cancer has spread to 3 or more lymph nodes, but each area of spread is less than 5 mm
  • N2b: The cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater
  • N2c: The cancer has spread to lymph nodes and has started growing through the outer covering of at least one of the lymph nodes (called extracapsular spread)

N3: The cancer has spread to the lymph nodes causing open sores (ulceration) or causing the lymph node to be stuck (fixed) to the tissue below it.

Distant spread of cancer (M)

M0: No distant spread

M1: The cancer has spread to distant sites (includes spread to pelvic lymph nodes)

Stage grouping

The grouping of T, N, and M determines the stage:

Stage 0 (Tis, N0, M0): This is a very early cancer found on the surface of the skin of the vulva only. It is also known as carcinoma in situ and as Bowen disease. This stage is not included in the FIGO system.

Stage I (T1, N0, M0): The cancer is in the vulva or the perineum (the space between the rectum and the vagina) or both. The tumor has not spread to lymph nodes or distant sites.

Stage IA (T1a, N0, M0): These are stage I cancers with tumors that are 2 cm or less that have grown into the underlying tissue no deeper than 1 mm (about 1/25 inch).

Stage IB (T1b, N0, M0): These are stage I cancers that have invaded deeper than 1 mm and/or are larger than 2 cm.

Stage II (T2, N0, M0): The cancer has grown outside the vulva or perineum to the anus or lower third of the vagina or urethra (T2). It has not spread to lymph nodes (N0) or distant sites (M0). In FIGO, this grouping is T2/T3, N0, M0, but it is still stage II.

Stage IIIA (T1 or T2, N1a or N1b, M0): Cancer is found in the vulva or perineum or both (T1) and may be growing into the anus, lower vagina, or lower urethra (T2). Either it has spread to a single nearby lymph node with the area of cancer spread 5 mm or greater in size (N1a); OR it has spread to 1 or 2 nearby lymph nodes with both areas of cancer spread less than 5 mm in size (N1b). It has not spread to distant sites (M0). In FIGO, this stage is also called IIIA.

Stage IIIB (T1 or T2, N2a or N2b, M0): Cancer is found in the vulva or perineum or both (T1) and may be growing into the anus, vagina, or lower urethra (T2). Either, the cancer has spread to 3 or more nearby lymph nodes, with all areas of cancer spread less than 5 mm in size (N2a); OR the cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater in size (N2b). The cancer has not spread to distant sites (M0). In FIGO, this stage is also called IIIB.

Stage IIIC (T1 or T2, N2c, M0): Cancer is found in the vulva or perineum or both (T1) and may be growing into the anus, lower vagina, or lower urethra (T2). The cancer has spread to nearby lymph nodes and has started growing through the outer covering of at least one of the lymph nodes (called extracapsular spread; N2c). The cancer has not spread to distant sites (M0). In FIGO, this stage is also called IIIC.

Stage IVA: Either of the following:

T1 or T2, N3, M0: Cancer is found in the vulva or perineum or both (T1) and may be growing into the anus, vagina, or lower urethra (T2). Cancer spread to nearby lymph nodes has caused them to be stuck (fixed) to the underlying tissue or caused open sores (ulceration) (N3). It has not spread to distant sites. In FIGO, this stage is also called IVA.

OR

T3, any N, M0: The cancer has spread beyond nearby tissues to the bladder, rectum, pelvic bone, or upper part of the urethra (T3). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant sites (M0). In FIGO, this stage is also called IVA.

Stage IVB (any T, any N, M1): Cancer has spread to distant organs or lymph nodes (M1). This is the most advanced stage of cancer. In FIGO, this stage is also called IVB.


Last Medical Review: 02/05/2013
Last Revised: 02/13/2014