Staging and grading

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond the area where it first started. Knowing the stage of the cancer will help you and your doctor decide on the most appropriate treatment.

This is a commonly used staging system for vulval cancer. It may help to look at the diagram of the vulva when you’re reading this.

Stage 1

The cancer is only in the vulva and/or perineum (the area between the vagina and the anus).

Stage 1 is further divided into:

Stage 1A

The cancer is 2cm or less in size, and has grown 1mm or less deep into the skin.

Stage 1B

The cancer is more than 2cm in size OR the cancer is any size and has grown more than 1mm deep into the skin.

Stage 2

The cancer is any size and has spread to other areas such as the lower part of the urethra, the vagina or the anus.

Stage 3

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

The cancer has spread to one lymph node that is 5mm or more in size OR the cancer has spread to one or two lymph nodes that are less than 5mm in size.

Stage 3B

The cancer has spread to two or more lymph nodes that are 5mm or more in size OR the cancer has spread to three or more lymph nodes that are less than 5mm in size.

Stage 3C

The cancer has spread to any number of lymph nodes, and it has also spread outside the capsule that surrounds the lymph node.

Stage 4

Stage 4 is divided into:

Stage 4A

The cancer is any size and has spread to other areas such as the urethra and/or vagina, the bladder or the rectum, or it has become fixed to the pelvic bone OR the cancer has spread to lymph nodes in the groin, and these lymph nodes have formed an ulcer or are not moveable.

Stage 4B

The cancer has spread to the lymph nodes in the pelvis, or to other parts of the body that are further away, such as the liver or lungs.

Gynaecologists often call stage 1 and 2 cancers early-stage cancers, and stage 3 and 4 cancers advanced-stage  cancers.

However, some gynaecologists only call stage 1 cancers early-stage cancers.

Grading

Grading is about how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to decide if you need further treatment after surgery.

  • Grade 1 or low-grade or well differentiated - The cancer cells look similar to normal cells and usually grow slowly and are less likely to spread.
  • Grade 2 or moderate-or intermediate-grade - The cancer cells look more abnormal and are slightly faster growing.
  • Grade 3 or high-grade or poorly differentiated - The cancer cells look very different from normal cells and may grow more quickly.

Back to Understanding your diagnosis

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Treatment overview

There are different treatments for vulval cancer. The treatment you have will depend on the stage of your cancer.

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