The FIGO/AJCC System for Staging Vulvar Cancer

The stage of vulvar 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 growing only in the vulva or perineum and is smaller than 2 cm. (about 0.8 inches).

• T1a: The cancer invades no more than 1 mm into underlying tissue.
• T1b: The cancer invades more than 1 mm into underlying tissue.

T2: The cancer is growing only in the vulva or perineum and is larger than 2 cm. (about 0.8 inches).

T3: The cancer is growing into the lower urethra, anus or vagina.

T4: The cancer is growing into the upper urethra, bladder or rectum or into the pubic bone.

Lymph Node Spread of Cancer (N)

N0: No lymph node spread

N1: Spread to lymph nodes on the same side as the cancerous vulva

N2: Spread to lymph nodes on the same and opposite side as the cancerous vulva

Distant Spread of Cancer (M)

M0: No distant spread

M1: The cancer has spread to distant sites

Stage Grouping

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

Stage 0: Tis, N0, M0: This is a very early cancer found in the surface of the skin of the vulva only. Stage 0 squamous cell cancer of the vulva is also known as carcinoma in situ and as Bowen disease.

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 is 2 cm or less (about 3/4 inch) in diameter and has not spread to lymph nodes or distant sites.

• Stage IA: T1a: These are stage I cancers with invasion no deeper than 1 mm (about 1/25 inch).
• Stage IB: T1b: These are stage I cancers that have invaded deeper than 1 mm.

Stage II: T2, N0, M0: The cancer is in the vulva or perineum or both, and the tumor is larger than 2 cm. It has not spread to lymph nodes or distant sites.

Stage III: T1-T2, N1, M0, or T3, N0-N1, M0: Cancer is found in the vulva or perineum or both and has spread to nearby tissues, such as the urethra, vagina, or anus, and/or has spread to nearby lymph nodes on one side of the groin. It has not spread to distant sites.

Stage IVA: T1-3, N2, M0, or T4, N0-N3, M0: Cancer has spread to lymph nodes on both sides of the groin or it has spread beyond nearby tissues to the upper part of the urethra, bladder, rectum, or pelvic bone.

Stage IVB: Cancer has spread to distant organs of the body. This is the most advanced stage of cancer.

Recurrent: The cancer has come back after treatment.

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 1997;80:505).

Stage	Relative 5-Years Survival Rate
I	93%
II	87%
III/IVA	43%

A recent report from the Mayo clinic divided patients into 2 groups – those with or without lymph node spread of the cancer. Women who had no lymph node spread had a 5-year survival of 96%. Those with spread to the lymph nodes had a 5-years survival of 64%. These survival numbers are disease-specific. This means that women who died of other causes than cancer were not included.

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 vulvar cancer. That means that relative survival only talks about deaths from vulvar 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 vulvar cancer. Last Revised: 06/21/2006