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, 3]
Table 1. TNM and FIGO Staging for Vulvar Cancer (Open Table in a new window)
Primary tumor (T) |
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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) |
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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 |
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Table 2. Anatomic Stage/Prognostic Groups (Open Table in a new window)
Stage |
TNM |
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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 |
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Rules of staging are as follows:
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This classification does not apply to mucosal malignant melanoma
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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 [4]
Tables
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 |
||
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 |
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