Vulvar Cancer: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see 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 should seek care from a gynecologic oncologist. This is a healthcare provider with advanced training in the diagnosis and management of vulvar cancer.

The staging systems for vulvar cancer

Sometimes doctors use different systems to stage cancer. Be sure to 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 staging system

• TNM staging system

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

• T tells how deep the main tumor has spread into the vulva and nearby tissue.

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

• M tells if the cancer has spread (metastasized) to distant organs in the body, such as the lungs, bones, or lymph nodes in another part of the body.

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 provider does not 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).

What are the stage groupings of vulvar cancer? 

Stage groupings are determined by combining the T, N, and M values from the TNM system. 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 through IV (1 through 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 to organs or tissues in other parts of the body. It's divided into these two sub-stages:

  • 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 organs in 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 sub-stages:

  • Stage IIIA. The cancer has spread either to one lymph node that is at least 5 mm across, or to one or two lymph nodes that are less than 5 mm across.

  • Stage IIIB.The cancer has spread to three or more lymph nodes that are no more than 5 mm across, or to two 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 (extracapsular spread).

• Stage IV.This stage is divided into two sub-stages:

  • 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 which 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, and/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, like the lungs or bone, or lymph nodes further away in the body. It may or may not have spread to nearby lymph nodes and organs.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you.  Make sure to ask questions and talk about your concerns.