Stage Information for Vulvar Cancer
The diagnosis of vulvar cancer is made by biopsy. The patient may be examined under anesthesia. Cystoscopy, proctoscopy, x-ray examination of the lungs, and intravenous urography (as needed), are used for staging purposes. Suspected bladder or rectal involvement must be confirmed by biopsy. The staging system does not apply to malignant melanoma of the vulva, which is staged like melanoma of the skin.Definitions: FIGO
The Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define vulvar cancer; the FIGO system is most commonly used.[1,2] Stage is based upon pathology staging at the time of surgery or prior to any radiation or chemotherapy, if they are the initial treatment modalities.Table 1. Carcinoma of the Vulvaa
|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 mmb, no nodal metastasis.|
|IB||Lesions >2 cm in size or with stromal invasion >1.0 mmb, 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 inguino-femoral lymph nodes.|
|IIIA||(i) With 1 lymph node metastasis (≥5 mm), or|
|(ii) 1–2 lymph node metastasis(es) (<5 mm).|
|IIIB||(i) With 2 or more lymph node metastases (≥5 mm), or|
|(ii) 3 or more lymph node metastases (<5 mm).|
|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.|
|aAdapted from FIGO Committee on Gynecologic Oncology.|
|bThe depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion.|
Grade is reported in registry systems. A two-, three-, or four-grade system may be used. If not specified, the following system is generally used:
- GX: Grade cannot be assessed.
- G1: Well differentiated.
- G2: Moderately differentiated.
- G3: Poorly differentiated.
- G4: Undifferentiated.
- Vulva. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 379-81.
- Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105 (2): 103-4, 2009. [PUBMED Abstract]
- Hopkins MP, Reid GC, Johnston CM, et al.: A comparison of staging systems for squamous cell carcinoma of the vulva. Gynecol Oncol 47 (1): 34-7, 1992. [PUBMED Abstract]