This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on June 7, 2022.
Following a vulvar cancer diagnosis, the care team determines the stage of disease before establishing a treatment plan. Staging cancer is one of the most important factors in evaluating treatment options and involves determining whether the cancer has spread, and if so, how aggressively. The stages are assigned a number between 0 and 4.
The care team uses a variety of diagnostic tests to evaluate vulvar cancer and develop an individualized treatment plan. If the patient has a recurrence, the care team performs comprehensive testing and identifies a treatment approach that is suited to the patient's needs.
The staging guidelines developed by the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC) system are used to stage vulvar cancers. This system allows doctors to communicate important information about the cancer in a standardized way. Vulvar cancer stages are based on three categories, as detailed below.
T (tumor): This describes the primary tumor size.
N (node): This indicates whether the vulvar cancer cells have spread to regional lymph nodes.
M (metastasis): This refers to whether the cancer has metastasized (spread to distant areas of the body).
Once the individual T, N and M scores have been established, an overall vulvar cancer stage is assigned.
This indicates an early-stage cancer restricted to the surface of the vulva. It may also be called carcinoma in situ.
The cancer is growing in the vulva and/or the perineum (the area between the anus and the opening of the vagina). The cancer has not spread to lymph nodes or other organs in the body. This stage has two subcategories, listed below.
Stage 1A: These tumors are 2 centimeters (cm) or smaller and have invaded no deeper than 1 mm into the underlying tissue of the vulva.
Stage 1B: These cancers are either larger than 2 cm or they have invaded deeper than 1 mm.
The disease has spread beyond the vulva and/or the perineum to the anus, the lower third of the vagina or the urethra. However, cancer cells have not spread to lymph nodes or other organs in the body.
This stage has three subcategories, listed below.
Stage 3A: The cancer is growing in the vulva and/or the perineum and may have spread to the anus, the lower third of the vagina or the urethra. It has either spread to one nearby lymph node with a total tumor spread size of greater than 5 millimeters (mm), or the total tumor spread is less than 5 mm, but cancer cells spread to one to two nearby lymph nodes. The cancer cells have not metastasized, or spread, to distant areas of the body.
Stage 3B: In this stage of vulvar cancer, the disease is growing in the vulva and/or the perineum and may have spread to the anus, the lower third of the vagina or the urethra. It has either spread to three or more nearby lymph nodes with a total tumor spread size of less than 5 mm, or it has spread to two nearby lymph nodes, and each area of nodal involvement is 5 mm or more. The cancer cells have not metastasized to distant areas of the body.
Stage 3C: The cancer is growing in the vulva and/or the perineum and may have spread to the anus, the lower third of the vagina or the urethra. The cancer cells have spread to nearby lymph nodes and have begun to grow outside of the covering layer of at least one lymph node. The cancer cells have not metastasized to distant areas of the body.
This stage has two subcategories, listed below.
Stage 4A: In this stage of vulvar cancer, the disease is growing in the vulva and/or the perineum and may have spread to the anus, the lower third of the vagina or the urethra. Cancer cells have spread to nearby lymph nodes and have caused them to become attached to nearby tissues or to develop open sores, or cancer cells have spread further to organs in the pelvis, such as the bladder, rectum, pelvic bone or upper part of the urethra. However, cancer cells have not yet reached distant organs.
Stage 4B: Cancers at this stage are the most advanced. Cancer cells have reached distant organs or lymph nodes farther from the pelvis.
Identifying the stage of cancer not only helps the care team determine a treatment plan, it also helps predict a potential prognosis. This is achieved by calculating the percentage of people with vulvar cancer who survive at least five years after diagnosis compared to people who don’t have that type of cancer. It’s important to remember that this is only a statistic based on all people with vulvar cancer several years in the past, so individual patient experiences may vary.
The American Cancer Society (ACS) shares vulvar cancer survival rates from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. The survival rate for vulvar cancer is based on where the cancer started and how far the cancer has spread, as indicated below.
Localized: The cancer has not spread outside the vulva. The five-year relative survival rate for localized vulvar cancer is about 86 percent.
Regional: The cancer has spread to nearby tissues or lymph nodes. The five-year relative survival rate for regional vulvar cancer is about 53 percent.
Distant: The cancer has spread to farther reaches of the body. The five-year relative survival rate for distant vulvar cancer is about 19 percent.
The overall five-year relative survival rate for vulvar cancer is 71 percent, according to the ACS.
Keep in mind that the survival rate for vulvar cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so always talk to the care team about the patient’s individual prognosis.
Next topic: How is vulvar cancer diagnosed?