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 explanation. Stage 1 and 2 cancers are often called early-stage cancers. Stage 3 and 4 cancers are called advanced-stage cancers.
-
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 the cancer is any size and has grown more than 1mm deep into the skin.
- Stage 1A
-
Stage 2
The cancer is any size and has spread locally to nearby areas such as:
- the lower part of the tube you pass urine through (urethra)
- the lower part of the vagina
- the anus.
It has not spread to lymph nodes.
-
Stage 3
The cancer has spread to nearby lymph nodes.
- Stage 3A
The cancer has spread to one lymph node. Or the cancer has spread to two lymph nodes that are 5mm or more in size. - Stage 3B
The cancer has spread to two or more lymph nodes that are less than 5mm in size. Or the cancer has spread to three or more lymph nodes that are 5mm or more in size. - Stage 3C
The cancer has spread to the lymph nodes, and has also spread outside the capsule that surrounds the lymph node.
- Stage 3A
-
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 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 (known as 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 with normal cells. The grade helps your doctor 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.
Who can I talk to for support?
We understand that waiting to know the stage of your cancer can be a worrying time. We're here if you need someone to talk to. You can:
- call the Macmillan Support Line on 0808 808 00 00
- chat online to our specialists.
About our information
-
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 cancerinformationteam@macmillan.org.uk
Morrison J, Baldwin P, Buckley L, et al. Gynaecological Cancer Society (BGCS) vulval cancer guidelines: recommendations for practice. 2020 [accessed November 2020].
Rogers LJ, and Cuello MA. Cancer of the vulva. Int J Gynaecol Obstet, 2018; 143, S2, 4-13. Available from https://doi.org/10.1002/ijgo.12609. [accessed November 2020].
-
Reviewers
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. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
How we can help