Staging and grading of vulval cancer
The stage of a cancer is a term used to describe its size and whether it has spread beyond the area of the body where it first started. Grading refers to the appearance of the cancer cells under a microscope.
Knowing the stage of the cancer will help you and your doctor to decide on the most appropriate treatment for you.
This is a commonly used staging system for vulval cancer:
The cancer is only in the vulva and/or perineum (the space between the anus and the vagina). Stage 1 can be further divided into Stage 1A and 1B, depending on the size of the cancer and how deeply into the skin of the vulva the cancer has grown:
Stage 1A - The cancer is 2cm or less in size and has grown 1mm or less into the skin.
Stage 1B - The cancer is more than 2cm in size OR is any size and has grown more than 1mm into the skin.
The cancer is any size and has spread to nearby structures, such as the lower part of the urethra (the tube that carries urine from the bladder), the vagina or the anus (the opening of the rectum).
The cancer has spread to the lymph nodes in the right or left side of the groin. Stage 3 is further divided into:
Stage 3A - There are one or two lymph node metastases that are 5mm or less in size OR there’s one lymph node metastasis that’s 5mm or greater in size.
Stage 3B - There are three or more lymph node metastases that are less than 5mm in size OR there are two or more lymph node metastases that are 5mm or greater in size.
Stage 3C - There are any number of lymph node metastases, and the cancer has spread outside the capsule that surrounds the lymph node.
Stage 4 is divided into:
Stage 4A - There are lymph node metastases in the groin that are ulcerated or have become fixed to other nearby structures OR the cancer is any size and has spread to nearby structures such as the upper two thirds of the urethra and/or vagina, the bladder or the rectum, or has become fixed to the pelvic bone. There may or may not be lymph node metastases.
Stage 4B - The cancer has spread to the lymph nodes in the pelvis or other parts of the body that are further away, such as the liver or lungs.
Gynaecologists often refer to stage 1 and 2 cancers as early-stage cancers and stage 3 and 4 cancers as advanced-stage cancers. However, some gynaecologists consider only stage 1 cancers as early-stage cancer.
The grade gives an idea of how quickly the cancer may develop.
The most commonly used system uses three grades:
Low-grade means that the cancer cells look very much like the normal cells of the vulva. They usually grow slowly and are less likely to spread.
Moderate-grade means that the cells look more abnormal than low-grade cells, but not as abnormal as high-grade cells.
High-grade means that the cells look very abnormal. They are likely to grow more quickly and are more likely to spread.
Knowing the grade of the cancer helps the doctors decide on the most appropriate treatment for you.