Vulvar cancer stages

Making an educated treatment decision begins with the stage, or progression, of the disease. 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 1 and 4, with stage 1 indicating the cancer has not spread to the lymph nodes or other organs in the body and stage 4 indicating advanced disease.

Our cancer doctors use a variety of diagnostic tests to evaluate vulvar cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your 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 common system allows doctors to communicate important information about the cancer in a standardized way. Vulvar cancer stages are based on three categories:

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 components are scored, they are combined to determine the overall stage group.

Stage 0: This indicates an early-stage cancer restricted to the surface of the vulva. It may also be called "carcinoma in situ."

Stage 1 vulvar cancer: 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:

• Stage 1A: These tumors are 2 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.

Stage 2 vulvar cancer: 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.

Stage 3 vulvar cancer: This stage has three subcategories:

• 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 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.

Stage 4 vulvar cancer: This stage has two subcategories:

• 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. Either 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.

Next topic: How is vulvar cancer diagnosed?