Vulval cancer (staging)

Staging of vulval cancer can be done with either the AJCC or FIGO systems, although both are similar. 

Staging

FIGO

• stage I:tumor confined to the vulva
  • IA lesions ≤2 cm in size, confined to the vulva or perineum and with stromal invasion ≤1.0 mm*, no nodal metastasis
  • IB: lesions N2 cm in size or with stromal invasion N1.0 mm*, confined to the vulva or perineum, with negative nodes
• stage II: tumor of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with negative nodes
• stage III :tumor of any size with or without extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive inguinal-femoral lymph nodes
  • IIIA: with 1 lymph node metastasis (≥5 mm), or 1–2 lymph node metastasis(es)
  • IIIB: with 2 or more lymph node metastases (≥5 mm), or 3 or more lymph node metastases
  • IIIC: with positive nodes with extracapsular spread
• stage IV: tumor invades other regional (2/3 upper urethra, 2/3 upper vagina), or distant structures
  • IVA :tumor invades any of the following:
    • (i) upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone, or
    • (ii) fixed or ulcerated inguino-femoral lymph nodes
  • IVB: any distant metastasis including pelvic lymph nodes

Practical points

• vulval melanoma cannot be staged using these systems ²

See also

• primary vulval cancer
• FIGO staging system