Vulvar Cancer Stages

What does vulvar cancer staging mean?

Staging describes how far cancer has grown or spread at the time of diagnosis. Doctors use staging information to select appropriate treatment and estimate prognosis. Vulvar cancer is commonly staged using systems developed by the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC).

The stage is based on factors such as:

• Tumor size

• Depth of invasion

• Spread to nearby structures

• Involvement of groin lymph nodes

• Spread to distant organs

Stage I vulvar cancer

Stage I means cancer is confined to the vulva and has not spread to lymph nodes.

Stage IA

The tumor measures 2 centimeters or less and has invaded no more than 1 millimeter into the underlying tissue.

Stage IB

The tumor is larger than 2 centimeters or has invaded more than 1 millimeter into the underlying tissue. Stage I cancers are often treated primarily with surgery.

Stage II vulvar cancer

Stage II means cancer has spread to certain nearby structures, such as the lower portion of the urethra, vagina, or anus, but has not spread to lymph nodes. Treatment often involves surgery, although radiation may be used in selected circumstances.

Stage III vulvar cancer

Stage III indicates more extensive local spread or involvement of regional lymph nodes. It may include cancer that has reached upper portions of nearby structures or spread to lymph nodes in the groin. Stage III is divided into substages:

• Stage IIIA: Includes certain nearby organ involvement or small regional lymph node metastases.

• Stage IIIB: Includes larger regional lymph node metastases.

• Stage IIIC: Includes cancer that has spread beyond the capsule surrounding an involved regional lymph node.

Treatment frequently involves a combination of surgery, radiation therapy, and sometimes chemotherapy.

Stage IV vulvar cancer

Stage IV describes the most advanced disease.

Stage IVA

Cancer may be fixed to the pelvic bone or involve fixed or ulcerated regional lymph nodes.

Stage IVB

Cancer has spread to distant sites, including distant organs or nonregional lymph nodes.

Treatment depends on the extent of disease and may include systemic therapy, radiation, surgery in selected circumstances, clinical trials, and supportive care. The staging descriptions above follow the revised FIGO framework, which differs in some respects from older staging systems.

What is tumor grade?

Tumor grade describes how abnormal cancer cells appear under a microscope.

In general:

• Grade 1: Cells resemble normal cells more closely.

• Grade 2: Cells show moderate abnormalities.

• Grade 3: Cells appear highly abnormal.

Higher-grade cancers may behave more aggressively, although grade is only one factor used to determine treatment and prognosis.

Why are lymph nodes important?

Vulvar cancer can spread through the lymphatic system to nodes in the groin. Finding cancer in these nodes can affect both treatment recommendations and prognosis. This is why lymph node assessment is an important part of staging for many patients with invasive vulvar cancer.