Vulvar Cancer Staging

Updated: Jan 22, 2015
  • Author: from Memorial Sloan-Kettering - Elizabeth L Jewell, MD, MHSc; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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Overview

Overview

The American Joint Committee on Cancer (AJCC) TNM classification system and the International Federation of Gynecology and Obstetrics (FIGO) staging system for vulvar cancer are provided in Table 1, below. [1, 2]

Table 1. TNM and FIGO Staging for Vulvar Cancer (Open Table in a new window)

Primary tumor (T)
TNM FIGO  
TX   Primary tumor cannot be assessed
T0   No evidence of a primary tumor
Tisa   Carcinoma in situ (preinvasive)
T1a IA Lesions ≤2 cm, confined to the vulva or perineum and with stromal invasion ≤1 mmb
T1b IB Lesions >2 cm or any size with stromal invasion >1 mm, confined to the vulva or perineum
T2 II Tumor of any size with extension to adjacent perineal structures (distal third of the urethra, distal third of the vagina, anal involvement)
T3 IVA Tumor of any size with extension to any of the following proximal two thirds of the urethra, proximal two thirds of the vagina, bladder mucosa, or rectal mucosa or fixed to pelvic bone
Regional lymph nodes (N)
TNM FIGO  
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1   1 or 2 regional (inguinofemoral) lymph nodes with the following features (see N1a, N1b)
N1a IIIA 1 or 2 lymph node metastases, each < 5 mm
N1b IIIA 1 regional lymph node metastasis ≥5 mm
N2   Regional (inguinofemoral) lymph nodes with the following features (see N2a, N2b, N2c)
N2a IIIB 3 or more lymph node metastases, each < 5 mm
N2b IIIB 2 or more regional lymph node metastases ≥5 mm
N2c IIIC Regional lymph node metastasis with extracapsular spread
N3 IVA Fixed or ulcerated regional lymph node metastasis
Distant metastasis (M)
TNM FIGO  
M0   No distant metastasis
M1 IVB Distant metastasis (including to pelvic lymph nodes)
a FIGO no longer includes stage 0 (Tis)



b Depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent, most superficial dermal papilla to the deepest point of invasion



Table 2. Anatomic Stage/Prognostic Groups (Open Table in a new window)

Stage TNM
0a Tis N0 M0
IA T1a N0 M0
IB T1b N0 M0
II T2 N0 M0
IIIA T1, T2 N1a, N1b M0
IIIB T1, T2 N2a, N2b M0
IIIC T1, T2 N2c M0
IVA T1, T2, T3 N3 M0
IVB Any T Any N M1
a FIGO no longer includes stage 0

Rules of staging are as follows:

  • This classification does not apply to mucosal malignant melanoma
  • FIGO uses surgical/pathologic staging for vulvar cancer
  • The pathology report should note the presence or absence of lymphovascular invasion
  • Stage should be assigned prior to radiation or chemotherapy if either of these is the initial mode of therapy
  • Cases with fewer than 6 lymph nodes resected are considered pNx by FIGO standards, unless these lymph nodes are positive for metastasis and are therefore N1; however, sentinel lymph node mapping is increasingly recognized in vulvar cancer and will likely be integrated into the next revision of staging criteria [3]