Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Staging for vulvar cancer depends on the size and location of the original tumor and whether the cancer has invaded nearby tissues and spread to other parts of the body. Staging is an important step in evaluating prognosis and treatment options.
Stage 0
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Description
- "Carcinoma in situ." Abnormal but non-invasive cells found on the surface of the vulva.
Treatment
- Local excision, laser surgery, ultrasound surgical aspiration, skinning vulvectomy, topical immunotherapy.
Stage Ia
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Description
- Tumor is confined to the vulva or perineum, is 2 cm or less in diameter, and has grown 1 mm or less into surrounding tissue.
Treatment
- Local excision, wide radical excision, vulvectomy (rarely).
Stage Ib
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Description
- Tumor is confined to the vulva or perineum, is more than 2 cm in diameter, and has grown more than 1 mm into surrounding tissue.
Treatment
- Wide radical excision plus unilateral or bilateral sentinel lymph node biopsy with or without inguinal lymphadenectomy; Radical vulvectomy plus unilateral or bilateral sentinel lymph node biopsy with or without inguinal lymphadenectomy; Radiation therapy.
Stage II
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Description
- Tumor is any size and has invaded the lower 1/3 of the vagina, the lower 1/3 of the urethra, or the anus.
Treatment
- Wide radical excision plus unilateral or bilateral sentinel lymph node biopsy with or without inguinal lymphadenectomy; Radical vulvectomy plus unilateral or bilateral sentinel lymph node biopsy with or without inguinal lymphadenectomy; Radiation therapy.
Stage IIIa
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Description
- Cancer has spread to 1 or 2 nearby lymph nodes, which are 5 mm or less in diameter.
- OR
- Cancer has spread to 1 nearby lymph node that is more than 5 mm in diameter.
Treatment
- Chemotherapy and/or radiation therapy with or without subsequent radical vulvectomy or modified radical vulvectomy.
Stage IIIb
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Description
- Cancer has spread to 3 or more nearby lymph nodes, which are 5 mm or less in diameter.
- OR
- Cancer has spread to 2 or more nearby lymph nodes that are 5 mm or greater in diameter.
Treatment
- Chemotherapy and/or radiation therapy with or without subsequent radical vulvectomy or modified radical vulvectomy.
Stage IIIc
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Description
- Cancer has invaded nearby lymph nodes and has spread to the outer surface of the nodes.
Treatment
- Chemotherapy and/or radiation therapy followed by radical vulvectomy or modified radical vulvectomy.
Stage IVa
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Description
- Cancer has spread to the upper 2/3 of the vagina, the upper 2/3 of the urethra, the bladder, rectum, or pelvic bone.
- OR
- Cancer has spread to nearby lymph nodes, which are fixed in place and/or ulcerated (with lesions).
Treatment
- Radical vulvectomy, pelvic exenteration, chemotherapy, radiation therapy.
Stage IVb
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Description
- Cancer has spread to pelvic lymph nodes or other parts of the body.
Treatment
- Radical vulvectomy, chemotherapy, radiation therapy.
