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Stages of vulval cancer

Women discussing vulval cancer

This page tells you about the stages and grades of vulval cancer. You can use these links to go straight down to sections about

 

A quick guide to what's on this page

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.

Grade

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).

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating vulval cancer section.

 

 

What stage means

The stage of cancer tells the doctor how large the cancer is and how far it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer. The lower the stage, the earlier the cancer has been diagnosed. Generally, the earlier a cancer is diagnosed, the more likely it is to be successfully treated and cured.

There are different ways of staging cancers. There is more about staging cancers in the about cancer section on how cancers grow. One staging system is the TNM (tumour, node, metastasis) and number system. Stage 0 is the earliest stage and stage 4 the most advanced.

In the UK, vulval cancer  is often staged according to the FIGO (International Federation of Gynaecology and Obstetrics) system. There are 4 main stages in this system. 

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva (local recurrence) or in another part of the body.

 

Vulval intraepithelial neoplasia

Vulval intraepithelial neoplasia (VIN) is not vulval cancer, but could turn into a cancer. There are abnormal cells in the surface layer of the vulva. Some doctors call it pre cancer although many women with VIN will not develop cancer. Some women with VIN may have severe itching or an area of abnormal tissue. There are 2 types of VIN

Usual type VIN is the most common type. Many women who have it have ongoing infection with high risk types of HPV (human papilloma virus). It occurs mainly in women aged between 30 and 40, and is more common in women who smoke. Usual type VIN can be divided into warty type, basaloid type and mixed type depending on different features. 

Up until fairly recently, usual type VIN was classified in a different way. It was divided into 3 grades called VIN 1, 2 and 3. The grade relates to the thickness of the surface layer of skin that is affected by abnormal cells. VIN 1 means less than a third of the skin covering the vulva has abnormal cells. VIN 2 means less than two thirds of the skin has abnormal cells. And VIN 3 means more than two thirds of the skin covering the vulva has abnormal cells. 

VIN 1 (low grade VIN) is generally a mild abnormality and usually goes away by itself. This is no longer classified as VIN as there is no clear evidence that there is a link with it and vulval cancer.

Doctors now group VIN 2 and 3 (high grade VIN) together to form the usual type VIN category. You usually have treatment for this as there is a risk that the abnormal cells may develop into cancer over time. But this risk is low. VIN 3 also used to be known as stage 0 or carcinoma in situ (CIS). But these days, stage 0 is no longer included in the FIGO staging system as it is not an invasive cancer. There is some debate between doctors as to which is the best classification to use for VIN, and so your doctor may still talk about VIN 1, 2 or 3.

Differentiated VIN is much less common and tends to occur in women between 50 to 60 years of age. It is not linked to HPV infection, but is commonly found in women who have a vulval condition called lichen sclerosus. Lichen sclerosus is inflammation of the vulval skin. Differentiated VIN has a higher risk of developing into cancer than usual type VIN. You can read about treatments for VIN in the vulval cancer treatment section.

 

Stage 1 vulval cancer

In stage 1, the cancer is found only in your vulva, or in the vulva and perineum (the space between the anus and the vagina). There is no obvious cancer in the lymph nodes.

Stage 1 can be divided into stages 1A and 1B. Stage 1A cancer is 2cm or less in size and has only grown 1 millimetre or less into the skin and tissues underneath. Stage 1B cancer measures more than 2cm across or has grown more than 1 millimetre into the skin and tissues underneath.

Diagram showing stage 1A and 1B cancer of the vulva

Doctors distinguish between these 2 groups because it is extremely rare for stage 1A cancers to have spread to the lymph nodes. So if you have a stage 1A cancer, your specialist may not think it necessary to remove lymph nodes to check for signs of spread.

If you have a stage 1B cancer, your specialist may be more likely to want to check your lymph nodes. But it is still not common for stage 1B cancers to spread to the lymph nodes.

 

Stage 2 vulval cancer

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) or the anus. There is no obvious cancer in the lymph nodes.

Diagram showing stage 2 cancer of the vulva

 

Stage 3 vulval cancer

Stage 3 means the cancer has spread into nearby lymph nodes. And it may have spread outside the lymph nodes into the surrounding tissue. 

Diagram showing stage 3 cancer of the vulva

Stage 3 is divided into stages 3A, 3B and 3C.

In stage 3A, the cancer has spread to 1 or 2 lymph nodes and these are smaller than 5mm OR the cancer has spread to 1 lymph node, and this is 5mm or larger in size.

In stage 3B, the cancer has spread to 3 or more lymph nodes and these are smaller than 5mm OR the cancer has spread to 2 or more lymph nodes and these are 5mm or larger in size.

In stage 3C, 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

Stage 4 vulval cancer is advanced cancer. This stage is divided into stages 4A and 4B.

In stage 4A, the cancer has spread into the urethra, the vagina or the lining of the anus. Or it has spread into the lining of the bladder or bowel. The affected lymph nodes in the groin may be fixed (stuck) to another structure or cause open sores (ulceration).

Diagram showing stage 4A cancer of the vulva

In stage 4B, the cancer has spread to the lymph nodes in your pelvis or other parts of your body further away from the vulva.

Diagram showing stage 4B cancer of the vulva

 

Grade in vulval cancer cells

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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Updated: 9 January 2014