Staging and grading

The stage of a cancer describes 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.

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

Staging

Stage 1

The cancer is only in the vulva, the area between the vagina and the anus (perineum), or in both these areas. It has not spread to lymph nodes.

Stage 1 is divided into two stages:

Stage 1A

The cancer is up to 2cm 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 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 3 is divided into three stages:

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 under 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 under 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 two stages:

Stage 4A

The cancer is any size and has either:

  • 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.

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