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:

• 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 about 3/4 inch (2 centimeters) or smaller and has only grown about 1 millimeter (less than 1/25 inch) into the tissue of the vulva.

  • Stage IB. In Stage IB, cancer is found only in the vulva and/or the perineum, but has spread more than 1 millimeter (mm) beneath the surface of the skin and/or has caused a tumor that is larger than 2 centimeters (cm).

• Stage II. In Stage II, cancer has spread beyond the vulva and perineum to the lower portion of the vagina or urethra (the tube through which urine passes from the bladder to outside the body) and/or anus. It has not spread to the lymph nodes or other organs. 

• Stage IIIA. In Stage IIIA, cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra, the vagina, and/or the anus (the opening of the rectum). In addition, the cancer has either spread to one nearby lymph node and the lesion is at least 5 mm or larger, or it has spread to one or two lymph nodes with a lesion smaller than 5 mm. The cancer has not spread to more distant sites in the body.

• Stage IIIB. In Stage IIIB, cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra, the vagina, and/or the anus. Also, the cancer has either spread to at least three lymph nodes with the size of the cancer spread less than 5 mm, or it has spread to two or more lymph nodes and the size of the cancer spread is larger than 5 mm. The cancer has not spread to more distant sites in the body.

• Stage IIIC. In Stage IIIC, cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra, the vagina, and/or the anus. Additionally, the cancer has spread to lymph nodes in the area and at least one of the nodes has cancer growing through its outer layer. The cancer has not spread to more distant sites in the body.

• 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 lower 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.