Stages of vulval cancer
Read about the stages and grades of vulval cancer. You can use these links to go straight down to sections about
Stages of vulval cancer
The stage of cancer tells doctors how large it is and how far it has spread. It is important because treatment is often decided according to the stage of a cancer.
Vulval cancer can be staged using the TNM and number system. TNM looks at the tumour size, whether cancer is in the lymph nodes, and whether it has spread to other organs (metastasised). There are 5 main stages. Stage 0 is the earliest and stage 4 the most advanced. In the UK, vulval cancers are often staged using the FIGO (International Federation of Gynaecological Oncology) system, which has stages from 1 to 4.
Recurrent disease means that the cancer has come back after treatment. It may come back in the vulva or in another part of the body.
Stages 0 to 4
Stage 0 is a very early stage, when abnormal cells are present only in the uppermost layer of skin of the vulva. It is sometimes called carcinoma in situ (CIS). This stage is not an invasive cancer. It is not included in the FIGO staging system.
In stages 1 and 2 the cancer is in the vulva or vulva and perineum only. In stages 3 and 4 the cancer has spread further away.
Cancer cells are graded according to how they look under a microscope. The more normal they look, the lower the grade. The lower the grade, the more slowly the cancer is likely to grow, and the less likely it is to spread or come back after treatment. Doctors usually look at stage and grade together to decide on the best treatment. Vulval cancer is usually graded from 1 (low grade) to 3 (high grade).
You can view and print the quick guides for all the pages in the Treating vulval cancer section.
The stage of cancer tells the doctor how large the cancer is and how far it has spread. You have tests and scans when the doctors are diagnosing your cancer. This gives information about the stage. It is important because doctors often decide about treatment according to the stage of a cancer
There are different ways of staging cancers. One staging system is the TNM (tumour, node, metastasis) and number system. Stage 0 is the earliest stage and stage 4 is the most advanced. Generally, the earlier the doctor diagnoses cancer, the more likely it is to be successfully treated and cured.
In the UK, doctors often stage vulval cancer according to the FIGO (International Federation of Gynaecology and Obstetrics) system. There are 4 main stages in this system. Read more about this further down this page.
Recurrent disease means that the cancer has come back (recurred) after treatment. It may come back in the vulva (local recurrence) or in another part of the body.
Vulval intraepithelial neoplasia (VIN) is a skin disease. Abnormal cells develop in the surface layers of the skin covering the vulva. It is not vulval cancer. But it could turn into a cancer. This may take many years. Some doctors call it pre cancer although many women with VIN will not develop cancer.
There are different grades of VIN. The grade refers to the thickness of the surface layer of skin affected by abnormal cells. You may have either VIN1, VIN 2 or VIN 3.
VIN 1 (low grade VIN) is generally a mild abnormality and usually goes away by itself. VIN 1 is no longer classified as VIN as there is no clear evidence that there is a link between it and vulval cancer.
Nowadays, doctors group VIN 2 and VIN 3 together. They refer to them both as high grade VIN.
Find out more about VIN.
In stage 1, the cancer is found only in your vulva, or in the vulva and perineum . The perineum is the space between the anus and the vagina. There is no obvious cancer in the lymph nodes.
Stage 1 is divided into stages 1A and 1B.
Stage 1A cancer is
- 2cm or less in size
- has only grown 1 millimetre or less into the skin and tissues underneath
Stage 1B cancer is
- more than 2cm across OR
- has grown more than 1 millimetre into the skin and tissues underneath
Doctors distinguish between stage 1A and stage 1B because it is extremely rare for stage 1A cancers to have spread to the lymph nodes. So if you have a stage 1A cancer, you WILL NOT need surgery to check if cancer has spread in to your lymph nodes.
If you have a stage 1B cancer, your specialist WILL want to check your lymph nodes. But it is still not common for stage 1B cancers to spread to the lymph nodes.
In stage 2, the cancer has spread from the vulva to nearby tissues such as
- the lower part of the vagina
- the lower part of the tube urine passes through (the urethra)
- the anus
There is no obvious cancer in the lymph nodes.
Stage 3 is divided into stages 3A, 3B and 3C. In stage 3, the cancer can be any size. It has spread into nearby lymph nodes. And it may have spread into the lower part of the urethra, the lower part of the vagina, or the anus.
Stage 3A can mean different things. We have 2 diagrams below to try to make it easier to understand.
Stage 3A can mean the cancer has spread to1 lymph node and this is 5mm or larger in size.
Or stage 3A can mean the cancer has spread to 1 or 2 lymph nodes and these are smaller than 5mm in size
Stage 3B can also mean different things. It can mean the cancer has spread to 2 or more lymph nodes and these are 5mm or larger in size.
Or stage 3B can mean the cancer has spread to 3 or more lymph nodes and these are smaller than 5mm in size.
Stage 3C means the cancer has spread to any number or lymph nodes AND it has spread outside the capsule that surrounds the lymph node.
Stage 4 vulval cancer is advanced cancer. This stage is divided into stages 4A and 4B
In stage 4A the cancer has either
- spread into the lining of the upper part of the vagina, the lining of the upper part of the urethra, the lining of the bladder or the lining of the anus
- attached on to the pelvic bone
- spread into nearby lymph nodes and the lymph node is either fixed, meaning it cannot move around, or it has formed an open sore called an ulcer
In stage 4B, the cancer has either
- spread to the lymph nodes in your pelvis OR
- spread to other parts of your body further away from the vulva.
Normal body cells are quite specialised. This means that cell types look different from one another under a microscope. So doctors can look at them and say where in the body they have come from. Doctors describe this development of cells as differentiation. Cancer cells are more primitive than normal cells and tend to have lost some or all of this specialisation.
Cancer cells are graded according to how they look under a microscope. In other words, they are graded according to how specialised they are. The more normal (or specialised) the cells look, the lower the grade. The lower the grade, the slower the cancer is likely to grow, the less likely it is to spread and the less likely it is to come back after successful treatment. This is only a rule of thumb. But doctors tend to look at stage and grade together in order to decide on the best treatment for you. Vulval cancer usually has 3 grades
- Grade 1 cells are low grade or well differentiated – they look very much like normal vulval cells
- Grade 2 cells are medium grade or moderately differentiated – they look more abnormal than grade 1 cells, but not so much as grade 3 cells
- Grade 3 cells are high grade or poorly differentiated – they are very unlike normal vulval cells
Sometimes cancer cells can be undifferentiated. These cells have lost all their specialisation. These may also be described as high grade. Unfortunately, undifferentiated cancers tend to be quite aggressive and fast growing. Sometimes, it is hard for a pathologist to decide where undifferentiated cancer cells originally came from in the body. So if you have undifferentiated cells in your lymph nodes, the pathologist cannot always tell what type of cancer it is.
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