Vulvar Cancer Stages

Vulvar cancer stages range from stage I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means the cancer has spread more. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage of vulvar cancer determined?

The 2 systems used for staging vulvar cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the AJCC (American Joint Committee on Cancer) TNM staging system basically are the same.

They both stage (classify) this cancer based on 3 pieces of information:

• The extent (size) of the tumor (T): How large and deep has the cancer grown? Has the cancer reached nearby structures or organs like the bladder or rectum?
• The spread to nearby lymph nodes (N): How many lymph nodes has the cancer spread to and has it grown outside of those lymph nodes?
• The spread (metastasis) to distant parts of the body (M): Has the cancer spread to distant lymph nodes or distant organs?

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

The staging system in the table below uses the pathologic stage (also called the surgical stage). It is determined by examining tissue removed during an operation. Sometimes, if surgery is not possible right away, the cancer will be given a clinical stage instead. This stage is based on the results of a physical exam, biopsy, and imaging tests done before surgery. For more information see Cancer Staging.

The system described below is the most recent FIGO system, effective January 2018.

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 Melanoma Skin Cancer.

Vulvar cancer staging can be complex, so ask your doctor to explain it to you in a way you understand. The FIGO staging system is most commonly used.

FIGO stage	Stage description*
IA	The cancer is in the vulva or the perineum (the space between the rectum and the vagina) or both and has grown no more than 1 mm into underlying tissue (stroma) and is 2 cm or smaller . It has not spread to nearby lymph nodes (N0) or to distant parts of the body.
IB	The cancer is in the vulva or the perineum or both and is either more than 2 cm or it has grown more than 1 mm into underlying tissue (stroma). It has not spread to nearby lymph nodes (N0) or to distant parts of the body.
II	The cancer can be any size and is growing into the lower third of the anus, vagina, or urethra (the tube that drains urine from the bladder) . It has not spread to nearby lymph nodes or to distant parts of the body .
IIIA	The cancer is growing into the upper two-thirds of the urethra, vagina, bladder mucosa, or rectal mucosa or it has spread to nearby lymph nodes with area of spread less than 5 mm. It has not spread to distant parts of the body.
IIIB	The cancer has spread to nearby lymph nodes with area of spread more than 5 mm . It has not spread to distant parts of the body.
IIIC	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). It has not spread to distant parts of the body.
IVA	The cancer has spread to pelvic bone or nearby lymph nodes and has become stuck (fixed) to the underlying tissue or has caused an ulcer(s) to form on the lymph node(s)(ulceration) . It has not spread to distant parts of the body .
IVB	The cancer has spread to distant organs such as lung or bones. The cancer can be any size and might or might not have spread to nearby organs. It might or might not have spread to nearby lymph nodes.

 

*  1 mm = 0.039 inches; 5 mm = 0.196 inches; 2 cm = .787 inches.