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)

You will have tests to stage and grade vulval cancer. The stage of a cancer explains its size and whether it has spread beyond the area it first started. Knowing the stage of the cancer helps you and your doctor decide on the best treatment options for you.

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.

The vulva
Image: The vulva


  • 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 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 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.

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:

About our information

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    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.

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