ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.
TNM staging system
One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:
Tumor (T): How large is the primary tumor? Where is it located?
Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?
The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
Here are more details on each part of the TNM system for vaginal cancer:
Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of cancer in the vagina.
Tis: The tumor is carcinoma in situ, an early cancer found only in 1 layer of cells that has not spread to nearby tissue.
T1: The tumor is in the vagina and has not spread through the vaginal wall or to other parts of the body.
T2: The tumor has spread through the vaginal wall and surrounding tissue, but not to the walls of the pelvis.
T3: The tumor has spread to the pelvic wall.
T4: The tumor has spread to the bladder, rectum, or other areas of the body.
The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the pelvis and groin are called regional lymph nodes. Depending on the exact location of the tumor (upper third, middle third, or lower third of the vagina), the lymph nodes near the hips or upper thighs may also be involved. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The lymph nodes cannot be evaluated.
N0: Cancer has not spread to the regional lymph nodes.
N1: Cancer has spread to the regional lymph nodes.
The "M" in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.
MX: Metastasis cannot be evaluated.
M0: The cancer has not spread to other parts of the body.
M1: The cancer has spread to another part of the body.
Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread.
GX: The tumor grade cannot be evaluated.
G1: The tumor cells are well differentiated (contain many healthy-looking cells).
G2: The tumor cells are moderately differentiated (more cells appear abnormal than healthy).
G3: The tumor cells are poorly differentiated (most of the cells appear abnormal).
G4: The tumor cells are undifferentiated (the cells barely resemble healthy cells).
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.
Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the vagina, not in the deeper tissue (Tis, N0, M0).
Stage I: The tumor has not spread through the vaginal wall or to other parts of the body (T1, N0, M0).
Stage II: The tumor has spread through the vaginal wall, but not to the walls of the pelvis (T2, N0, M0).
Stage III: Vaginal cancer is called stage III in either of these conditions:
Cancer has spread to the lymph nodes in the pelvis (T1, T2, or T3; N1, M0).
Cancer has spread to the pelvic wall (except the bladder), but not the lymph nodes (T3, N0, M0).
Stage IVA: Cancer has spread to the bladder, rectum, or beyond the pelvis. The lymph nodes may or may not be involved (T4, any N, M0).
Stage IVB: Any cancer that has spread to a distant part of the body (any T, any N, M1).
Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.
Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org.
Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Use the menu to choose a different section to continue reading in this guide.