Stages and grades of vulval cancer

The stage and grade of vulval cancer help your doctor decide which treatment you need.

Staging means describing the size of the cancer and how far it has grown. The grade tells you about how abnormal the cells look under a microscope.

Your team looks at the results of your tests and scans to find out about the stage and grade. Ask your doctor or specialist nurse if you have any questions about the stage or grade of your cancer. 

How do doctors stage vulval cancer?

There are different ways of staging vulval cancer. In the UK, doctors usually use the FIGO system. FIGO stands for International Federation of Gynaecology and Obstetrics. There are 4 main stages – from 1 to 4.

Your doctor may also tell you the TNM stage. Or you may see it on your pathology report. TNM stands for Tumour, Node, Metastasis:

• T describes the size of the 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

Below, we describe the FIGO staging system.

Stage 1

Stage 1 means that the cancer is only in the vulva. There is no sign of cancer in the lymph nodes .

Stage 1 is divided into stages 1A and 1B.

Stage 1A means that the cancer:

• is 2 cm or less in size
• has only grown 1 mm or less into the skin and tissues underneath

Stage 1B cancer means one of the following:

• the cancer is more than 2 cm across
• has grown more than 1 mm into the skin and tissues underneath

Stage 2

Stage 2 vulval cancer means the cancer has spread to nearby tissues such as:

• the lower part of the vagina
• the lower part of the tube that carries urine from the bladder to the outside of the body. This is the urethra
• the lower part of the opening to the back passage. This is the anus.

There is no sign of cancer in the lymph nodes.

Stage 3

In stage 3, the cancer can be any size and it has spread into nearby tissues and lymph nodes. It is divided into stages 3A, 3B and 3C.

Stage 3A

Stage 3A means that the cancer has spread to:

• the upper part of the urethra
• the upper part of the vagina
• the lining of the bladder (bladder mucosal)
• the lining of the back passage (rectal mucosal)

Or stage 3A means that the cancer has spread to lymph nodes and these are smaller than 5mm in size.

Stage 3B

Stage 3B means that the cancer has spread to 1 or more lymph nodes and these are 5mm or larger in size. 

Stage 3C

Stage 3C means the cancer has spread to the lymph nodes and it has spread outside the capsule that surrounds them.

Stage 4

Stage 4 vulval cancer is advanced cancer. It is also called metastatic vulval cancer. It is divided into stages 4A and 4B.

Stage 4A

In stage 4A the cancer has spread to:

• the pelvic bone
• the 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

Stage 4B

In stage 4B, the cancer has spread to other parts of your body further away from the vulva. For example, it has spread to the lungs.

Grades of vulval cancer

The grade of a cancer is a way of measuring how abnormal cancer cells are compared to healthy cells. It gives an idea of how quickly a cancer may grow and whether it is likely to spread.

Low grade cancers are usually slower growing and less likely to spread. High grade cancers tend to be faster growing and more likely to spread.

There are 3 grades of vulval cancer – from grade 1 to grade 3:

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

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 cell the cancer started in
• your age and general health
• how you feel about what the treatments involve and the side effects

Treatments you might have include surgery, radiotherapy and chemotherapy.