Vulvar Cancer: Stages

The stage of a cancer is how much cancer there is and how far it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. Imaging scans can show if the cancer has spread to nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The staging of vulvar cancer can be very confusing. Women with this cancer should see a gynecologic oncologist. This is a healthcare provider with advanced training in the diagnosis and management of vulvar cancer.

Sometimes healthcare providers use different systems to stage cancer. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

There are two systems used most often to stage vulvar cancer:

• FIGO (International Federation of Gynecology and Obstetrics) staging system

• AJCC (American Joint Committee on Cancer) staging system

The two systems are much the same. They both use the TNM system. Here's what these letters stand for:

• T tells how big the main tumor is and how deep it has spread into the vulva and nearby tissues or organs.

• N tells if the lymph nodes near the original tumor have cancer in them.

• M tells if the cancer has spread ( metastasized) to distant parts of the body, such as the lungs, bones, or lymph nodes not near the vulva.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

• X means the healthcare provider doesn't have enough information to tell the extent of the main tumor (TX) or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of the main tumor (T0).

Stage groupings are based on the T, N, and M values. These groupings give an overall description of your cancer.

A stage grouping is listed as a Roman numeral and can have a value of I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is.

Invasive vulvar cancer is staged as follows. It’s based on findings and pathology from surgery. Vulvar melanoma stages are different and not covered here.

• Stage I . Cancer is found in the vulva or the space between the opening of the rectum and the vagina (perineum) or both. It has not spread to nearby lymph nodes or other parts of the body. It's divided into these two substages:
  • Stage IA. The tumor is no more than 2 centimeters (cm) across. It has grown no more than 1 millimeter (mm) deep into the tissue of the vulva.
  • Stage IB. The tumor is more than 2 cm across or has spread more than 1 mm beneath the surface of the vulvar skin.
• Stage II . The tumor is any size. It has spread outside the vulva to nearby sites. These can include the urethra (the tube that carries urine out of the bladder), lower vagina, or anus. It has not spread to lymph nodes or other parts of the body.
• Stage III . The cancer is in the vulva or the perineum or both. It may or may not have spread to the urethra, lower vagina, or anus. It has not spread to organs in other parts of the body. It's divided into these three substages:
  • Stage IIIA. The cancer has spread either to 1 lymph node that's at least 5 mm across, or to 1 or 2 lymph nodes that are less than 5 mm across.
  • Stage IIIB. The cancer has spread to 3 or more lymph nodes that are no more than 5 mm across, or to 2 or more lymph nodes that are more than 5 mm across.
  • Stage IIIC. The cancer has spread to nearby lymph nodes and at least one of the nodes has cancer growing through its outer layer (called extracapsular spread).
• Stage IV . This stage is divided into two substages:
  • Stage IVA . The cancer has not spread to organs in other parts of the body, and one of these is true:
    • The cancer is in the vulva or the perineum or both. It may or may not have spread to the urethra, lower vagina, or anus. It has spread to nearby lymph nodes that are stuck to deeper tissues or have ulcerated.
    • The cancer has spread beyond nearby tissues to the upper part of the urethra, upper vagina, bladder, rectum, or pelvic bone. It may or may not have spread to nearby lymph nodes.
  • Stage IVB . This is the most advanced stage of vulvar cancer. The cancer has spread to organs, such as the lungs or bone, or to lymph nodes farther away in the body. It may or may not have spread to nearby lymph nodes and organs.

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Ask any questions and talk about your concerns.