Stages and grades for vaginal cancer

The stage of vaginal cancer tells you about its size and whether it has spread. The grade tells you how abnormal the cells look under the microscope. This helps your doctor decide which treatment you need.

Different staging systems for vaginal cancer

There are different ways of staging vaginal cancer. In the UK, doctors usually use the International Federation of Gynaecology and Obstetrics (FIGO) staging system. 

There are 4 stages. Stage 1 is the earliest stage and stage 4 is the most advanced stage.

Doctors may also use the TNM staging system. TNM stands for Tumour, Node, Metastasis:

• T describes the size of the tumour (cancer)
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

Stage 1

Stage 1 vaginal cancer means that the cancer is only in the vagina. It hasn’t spread to the lymph nodes close to the vagina, or to other body parts. 

In TNM staging this is the same as T1a or T1b, N0, M0.

Stage 2

Stage 2 means that the cancer has spread outside the vagina into the surrounding tissues. It has not reached the walls of the pelvis or nearby lymph nodes. It hasn’t spread to other body parts. 

In TNM staging this would be the same as T2a or T2b, N0, M0.

Stage 3

Stage 3 vaginal cancer has spread outside the vagina. It might have reached the lower part or the vagina or the wall of the pelvis. Or it might cause a blockage that stops you having a wee. This can cause problems with your kidneys.

The cancer might have spread to nearby lymph nodes, but it hasn’t spread to other body parts.

In TNM staging this would be the same as T1 to T3, N1, M0. Or T3, N0, M0.

Stage 4

This stage is advanced vaginal cancer. This means that the cancer has spread to other body organs outside the vagina. This is also called metastatic vaginal cancer.

Stage 4 is divided into 2 groups. 

Stage 4A is when the cancer has spread to your bladder or back passage (rectum). It might have spread to nearby lymph nodes, but it hasn’t spread to other body parts.

In TNM staging, this is the same as T4, any N, M0.

Stage 4B is when the cancer has spread to organs further away, such as the lungs or the bones. It might have spread to nearby lymph nodes.

In TNM staging, this is the same as any T, any N, M1.

Grades of vaginal cancer

The grade means how abnormal the cancer cells look under a microscope. Knowing the grade gives your doctor an idea of how the cancer might behave and what treatment you need

Grade 1

The cells look very like normal cells. They are also called low grade or well differentiated. They tend to be slow growing and are less likely to spread than higher grade cancer cells.

Grade 2

The cells look more abnormal and are more likely to spread. This grade is also called moderately differentiated or moderate grade.

Grade 3

The cells look very abnormal and not like normal cells. They tend to grow quickly and are more likely to spread. They are called poorly differentiated or high grade.

Treatment for vaginal cancer

Your doctor looks at the stage and grade of the cancer and suggest the best treatment for you. They also consider other things when recommending treatment:

• the type of vaginal cancer you have
• the stage of your cancer
• which part of your vagina is affected by cancer
• any previous treatment you might have had
• your age and general health
• how you feel about what the treatments involve and the side effects

The treatments you might have include:

• radiotherapy
• surgery
• chemotherapy and radiotherapy together (chemoradiotherapy)
• chemotherapy