Staging and grading of vulval cancer
The stage and grade of a cancer is used to describe its size and how quickly it may grow.
Staging of vulval cancer (vulvar cancer)
Number staging
The number staging system is often used for vulval cancer. It may help to look at the diagram of the vulva below when you are reading this. Stage 1 and 2 cancers are often called early stage cancers. Stage 3 and 4 cancers are called advanced stage cancers.
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Stage 1
The cancer is only in the vulval area and has not spread to the lymph nodes.
- Stage 1A
The cancer is up to 2cm in size and has grown up to 1mm deep into the skin. - Stage 1B
The cancer is more than 2cm in size, or it has grown more than 1mm deep into the skin.
- Stage 1A
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Stage 2
The cancer is any size and has spread to nearby areas, such as the:
- lower part of the urethra – this is the tube you pass urine through
- lower part of the vagina
- anus.
It has not spread to lymph nodes.
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Stage 3
The cancer is any size and has spread to nearby areas. It may have spread to nearby lymph nodes.
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Stage 3A
The cancer has spread to the:
- upper part of the urethra
- upper part of the vagina
- bladder
- rectum.
Or, the cancer has spread to the nearby lymph nodes, but they are 5mm or smaller in size.
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Stage 3B
The cancer has spread to the lymph nodes, and they are more than 5mm in size.
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Stage 3C
The cancer has spread to the lymph nodes and has also spread outside the capsule that surrounds the lymph node.
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Stage 4
Stage 4 is divided into two stages.
- Stage 4A
The cancer is any size and has done any of the following:- spread into the upper part of the urethra, the vagina, the bladder or the rectum
- become fixed to the pelvic bone
- spread to lymph nodes in the groin, and these lymph nodes have formed an ulcer or cannot be moved (have become fixed).
- Stage 4B
The cancer has spread to:- the lymph nodes in the pelvis
- other parts of the body that are further away, such as the lungs.
- Stage 4A
TNM staging
Another staging system called TNM staging is sometimes used. TNM stands for tumour, node and metastases.
T describes the size of the tumour. This is usually a number between 1 and 4. 1 is a small cancer and 4 is a larger or more advanced cancer.
N describes whether the cancer has spread to the lymph nodes. The number can be between 0 and 3. 0 means there are no cancer cells in the lymph nodes. 3 means more lymph nodes are affected by cancer.
M describes whether the cancer has spread to another part of the body. This is called metastatic or secondary cancer. The number is either 0 or 1. 0 means the cancer has not spread to other parts of the body. 1 means it has spread.
Grading of vulval cancer
Grading is how the cancer cells look under the microscope compared to normal cells. The grade helps your doctor decide whether you need further treatment after surgery:
- Grade 1 or low grade or well differentiated means the cancer cells look similar to normal cells, and they usually grow slowly and are less likely to spread.
- Grade 2 or moderate grade or intermediate grade means the cancer cells look more abnormal, and they are slightly faster growing.
- Grade 3 or high grade or poorly differentiated means the cancer cells look very different from normal cells, and they may grow more quickly.
Grading is now less commonly used in vulval cancer. This is because doctors can tell more about how cancer cells may behave if an infection called human papilloma virus (HPV) is present in the vulval cancer cells. HPV is the main risk factors for vulval cancer.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our vulval cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Morrison J, Baldwin P, Hanna L, Andreou A, Buckley L, Durrant L, et al. British Gynaecological Cancer Society (BGCS) vulval cancer guidelines: An update on recommendations for practice 2023. European Journal of Obstetrics and Gynaecology and Reproductive Biology. 2024;292: 210–238. Available from: www.doi.org/10.1016/j.ejogrb.2023.11.013 [accessed July 2026].
The Royal College of Radiographers. The Royal College of Radiologists expert panel recommendations for radiotherapy treatment for vulval cancer. 2024. Available from: www.rcr.ac.uk/media/l1zjohkm/rcr-vulval-cancer-treatment-recommendations.pdf [accessed July 2026]
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