Staging, the process of finding out how far the cancer has spread, is very important because your treatment options and the outlook for your recovery and survival (prognosis) depend on the stage of your cancer.

The stage of vaginal cancer is most often described using the FIGO (International Federation of Gynecology and Obstetrics) System of Staging combined with the American Joint Committee on Cancer 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. The definition of T, N and M is as follows:

Tumor Extent (T)

• Tis: The cancer is not invading into the underlying tissues.
• 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.

Lymph Node Spread of Cancer (N)

• N0: No lymph node spread
• N1: Spread to lymph nodes in the pelvis or groin

Distant Spread of Cancer (M)

• M0: No distant spread
• M1: The cancer has spread to distant sites.

Stage 0: T1s, N0, M0: In this stage, cancer cells are limited to the epithelium (lining layer) of the vagina and have not spread to other 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).

Stage I: T1, N0, M0: The cancer has invaded (spread beneath) the epithelium but is confined to the vaginal mucosa (lining). (The mucosa is formed by 2 layers – the epithelium and the lamina propria or subepithelial stroma). Same as FIGO stage I.

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, to other organs, or to lymph nodes. (The pelvis is the internal cavity of the lower trunk that surrounds the internal female reproductive organs, the rectum, the bladder, and parts of the large intestine.) Same as FIGO stage II.

Stage III: T1,2, N1, M0; T3, N0,1, M0: Cancer extends to the wall of the pelvis and/or has spread to lymph nodes. FIGO stage III is only cancer extending to the wall of the pelvis. Lymph nodes are not considered.

Stage IVA: T4, Any N, M0: Cancer has spread to organs next to the vagina (such as the bladder or rectum). It may or may not have spread to lymph nodes. FIGO stage IV.

Stage IVB: Any T, Any N, M1: Cancer has spread to distant organs such as the lungs. Not in FIGO.

Recurrent: Recurrent disease is not an actual stage but means that the cancer has come back (recurred) after treatment has taken place. Vaginal cancer usually recurs locally (near the vagina) but may also recur in distant locations.

Survival by Stage

The numbers below are based on patients diagnosed from 1985 to 1989. Because of newer treatments, the survival rates for women diagnosed now should be better. These numbers come from the American College of Surgeons, National Cancer Data Base. (Cancer 1998;83:1033)

Stage	Relative 5-Years Survival Rate
0	96%
I	73%
II	58%
III/IV	36%

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Five-year rates are used to produce a standard way of discussing prognosis. Of course, many people live much longer than 5 years. Five-year relative survival rates assumes that people will die of other causes and compares the observed survival with that expected for people without vaginal cancer. That means that relative survival only talks about deaths from vaginal cancer.

Keep in mind that 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a more favorable outlook for women more recently diagnosed with vaginal cancer. Last Revised: 07/21/2006