Vulval cancer (staging)

Last revised by Rohit Sharma on 22 Jun 2023

Staging of vulval cancer can be done with either the AJCC or FIGO systems, although both are similar. 

  • stage I: tumor confined to the vulva

    • IA: lesions ≤2 cm in size, confined to the vulva or perineum and with stromal invasion ≤1.0 mm*, no nodal metastasis

    • IB: lesions N2 cm in size or with stromal invasion N1.0 mm*, confined to the vulva or perineum, with negative nodes

  • stage II: tumor of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with negative nodes

  • stage III: tumor of any size with or without extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive inguinal-femoral lymph nodes

    • IIIA: with 1 lymph node metastasis (≥5 mm), or 1–2 lymph node metastasis(es)

    • IIIB: with 2 or more lymph node metastases (≥5 mm), or 3 or more lymph node metastases

    • IIIC: with positive nodes with extracapsular spread

  • stage IV: tumor invades other regional (2/3 upper urethra, 2/3 upper vagina), or distant structures

    • IVA: tumor invades any of the following:

      • (i) upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone, or

      • (ii) fixed or ulcerated inguino-femoral lymph nodes

    • IVB: any distant metastasis including pelvic lymph nodes

  • vulval melanoma cannot be staged using these systems 2

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