Vulvar Cancer: Stages

Approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished.

Knowing the stage helps the doctor to 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 of vulvar cancer: 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 vulvar cancer:

Tumor (T)

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 also 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 tumor.

Tis: The tumor is carcinoma in situ, an early cancer on the surface of the skin that has not spread to nearby tissue.

T1: The tumor is only in the vulva, or the vulva and perineum (the area of skin between the anus and vagina), and is 2 centimeters (cm) or smaller.

T1a: The tumor is only in the vulva, or the vulva and perineum, is 2 cm or smaller, and has spread no more than 1 millimeter (mm) into nearby structures.

T1b: The tumor is only in the vulva, or the vulva and perineum, is 2 cm or smaller, and has spread more than 1 mm into nearby structures.

T2: The tumor is only in the vulva, or the vulva and perineum, and is larger than 2 cm.

T3: The tumor, of any size, has spread to the lower urethra and/or the vagina or anus.

T4: The tumor has spread to any of the following: upper urethra, bladder mucosa, rectal mucosa, or is attached to the pubic bone.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. Lymph nodes near the pelvis and groin are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0: Cancer has not spread to the lymph nodes.

N1: Cancer has spread to lymph nodes on the same side of the body as the tumor.

N2: Cancer has spread to lymph nodes on both sides of the body.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0: There is no distant metastasis.

M1: There is metastasis to other parts of the body.

Grade (G)

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. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be evaluated.

G1: The tumor cells contain many healthy-looking cells and are well differentiated.

G2: The tumor cells appear more abnormal than healthy and are moderately differentiated.

G3: Most of the tumor cells appear abnormal and are poorly differentiated.

G4: The tumor cells barely resemble healthy cells and are undifferentiated.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: The cancer has not spread from where it started and is on the surface of the skin of the vulva only (Tis, N0, M0).

Stage I: The tumor is smaller than 2 cm and has not spread (T1, N0, M0).

Stage IA: The tumor is smaller than 2 cm, has not spread, and is no deeper than 1 mm (T1a, N0, M0).

Stage IB: The tumor is smaller than 2 cm, has not spread, and is deeper than 1mm (T1b, N0, M0).

State II: The tumor is larger than 2 cm, is in the vulva or perineum or both, but has not spread to nearby tissue (T2, N0, M0).

Stage III: The cancer has spread to nearby tissue (vagina, anus, urethra) and/or lymph nodes on one side of the body, but there is no distant metastasis (T1 or T2, N1, M0; T3, N0 or N1, M0).

Stage IVA: The cancer has spread to lymph nodes on both sides of the body or spread into the upper part of the urethra, bladder, rectum, or pelvic bone (T1, T2, T3; N2, M0; or 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,

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.