Vulvar Cancer Stages

The process used to find out if cancer has spread within the vulva or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Proctoscopy: A procedure to look inside the rectum and anus to check for abnormal areas, using a proctoscope. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the rectum and anus. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Chest x-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage vulvar cancer, x-rays may be taken of the organs and bones inside the chest.
• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters and bladder, x-rays are taken to see if there are any blockages. This procedure is also called intravenous urography.
• Biopsy: The removal of cells or tissues from the bladder or rectum so they can be viewed under a microscope by a pathologist to check for signs of cancer, if it is suspected that cancer has spread there.

In vulvar intraepithelial neoplasia (VIN), abnormal cells are found on the surface of the vulvar skin.

These abnormal cells are not cancer. Vulvar intraepithelial neoplasia may become cancer and spread into nearby tissue. VIN is sometimes called stage 0 or carcinoma in situ.

In stage I, cancer has formed. The tumor is found only in the vulva. Stage I is divided into stages IA and IB.

In stage IA, the tumor is 2 centimeters or smaller and has spread 1 millimeter or less into the tissue of the vulva. Cancer has not spread to the lymph nodes.

In stage IB, the tumor is larger than 2 centimeters or has spread more than 1 millimeter into the tissue of the vulva. Cancer has not spread to the lymph nodes.

In stage II, the tumor is any size and has spread to the lower one-third of the urethra, the lower one-third of the vagina, or the lower one-third of the anus. Cancer has not spread to the lymph nodes.

In stage III, the tumor is any size and has spread to the upper two-thirds of the urethra, the upper two-thirds of the vagina, the inner lining of the bladder or rectum, or to any number of lymph nodes. Stage III is divided into stages IIIA, IIIB, and IIIC.

• In stage IIIA, cancer is found in lymph nodes in the groin that are not larger than 5 millimeters.
• In stage IIIB, cancer is found in lymph nodes in the groin that are larger than 5 millimeters.
• In stage IIIC, cancer is found in lymph nodes in the groin and has extended through the outer covering of the lymph nodes.

In stage IV, the tumor is any size and has become attached to the bone, or cancer has spread to lymph nodes that are not movable or have become ulcerated, or there is distant spread. Stage IV is divided into stages IVA and IVB.

• In stage IVA, the cancer is attached to the pelvic bone or has spread to lymph nodes in the groin that are not movable or have become ulcerated.
• In stage IVB, the cancer has spread beyond the pelvis to distant parts of the body.

Stage IV vulvar cancer is also called metastatic vulvar cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if vulvar cancer spreads to the lung, the cancer cells in the lung are actually vulvar cancer cells. The disease is called metastatic vulvar cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Recurrent vulvar cancer is cancer that has come back after it has been treated. If vulvar cancer comes back, it may come back in the vulva or in other parts of the body, such as the lung. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent vulvar cancer will depend on where it has come back.
Learn more in Recurrent Cancer: When Cancer Comes Back.