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Understanding the Stages of Vulvar Cancer

What are the Stages of Vulvar Cancer?

The stage of cancer tells how much cancer there is and how far it has spread. By using exams and tests, a doctor can tell the stage of a person's vulvar cancer. A cancer's stage is one of the most important factors in deciding the best treatment for the cancer. Stage 0 or carcinoma in situ is a very early lesion. The lesion is found only in the surface of the skin.

Invasive vulvar cancer is staged as follows, based on findings and pathology from surgery: 

  • Stage I. In Stage I, cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (called the perineum). The lymph glands do not contain cancer and it has not spread to other organs or tissues elsewhere in the body: 

    • Stage IA. The tumor is less than or equal to 3/4 inch (2 centimeters) in diameter and has grown no more than 1 millimeter (less than 1/25 inch) into the tissue of the vulva. It has not spread to the lymph nodes.

    • Stage IB. In Stage IB, cancer is greater than 2 centimeters in diameter or has spread more than 1 millimeter (mm) beneath the surface of the skin. The tumor is found only in the vulva and/or the perineum and has not spread to the lymph nodes.

  • Stage II. The tumor is any size and has spread to adjacent perineal sites such as the lower urethra, lower vagina, or anus, but has not spread to lymph nodes.

  • Stage III. In stage III,  the tumor is any size and has spread to nearby (inguinal or femoral) lymph nodes. It may or may not have spread to adjacent site such as the lower urethra, lower vagina, or anus.

  • Stage IIIA. The cancer has spread either to a single lymph node metastasis of up to 5 mm or to one or two lymph nodes metastases  that are smaller than 5 mm..

  • Stage IIIB. The cancer has spread to two or more lymph node metastases that are at least 5 mm, or to three or more lymph node metastases that are smaller than 5 mm.

  • Stage IIIC. The cancer has spread to the lymph nodes in the groin, and at least one of the nodes has cancer growing through its outer layer (known as extracapsular spread).

  • Stage IVA. In Stage IVA, either of these situations is found: 

    • Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the upper part of the urethra, the vagina, and/or the anus. Nearby lymph nodes in which cancer is found have become attached to the surrounding tissues or have ulcerated (leading to open sores). The cancer has not spread to distant organs in the body.  

    • Cancer has spread from the vulva and/or perineum into the bladder, rectum, pelvic bone, or further up the urethra. Nearby lymph nodes may or may not be involved. The cancer has not spread to more distant sites in the body.

  • Stage IVB. This is the most advanced stage of vulvar cancer, in which the cancer has spread to organs, tissues, and/or lymph nodes further away in the body.  

  • Recurrent. Recurrent cancer means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva or another place.

The staging of vulvar cancer can be very confusing. People should seek out care from a gynecologic oncologist, a subspecialist with advanced training in the diagnosis and management of vulvar cancer.

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