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...
  • Print
Sections
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]