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Stages and grades

Read about the stages and grades of vulval cancer. 

What stage means

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 vulval cancers.

TNM (tumour, node, metastasis) and number staging system

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.

FIGO staging system

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.

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)

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.

What grade means

Normal body cells are quite specialised so cell types look different from one another under a microscope. Doctors can tell where in the body they have come from. They 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.

Doctors tend to look at stage and grade together in order to decide on the best treatment for you.

Grades of vulval cancer 

  • 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

Cancer cells can be undifferentiated and lose all their specialisation. They may be described as high grade. Undifferentiated cancers tend to be quite aggressive and fast growing.

Sometimes, it is hard for a pathologist to decide where undifferentiated cancer cells came from in the body. If you have undifferentiated cells in your lymph nodes, the pathologist cannot always tell what type of cancer it is.

Last reviewed: 
06 Jul 2016
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    S Edge and others (2010)

    Springer

  • Premalignant lesions of the lower female genital tract: cervix, vagina and vulva

    McCluggage WG (2013) 

    Pathology Apr;45(3):214-28

  • Management of vulvar intrepithelial neoplasia: ISSVD classification 

    The american college of obstetricians and gynaecologists (2004)

  • Cancer of the vulva (FIGO cancer report 2012) 

    F Hacker and others (2012) 

    International Journal of Gynecology and Obstetrics 119S2 (2012) S90–S96

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