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Staging of vulvar cancer

According to FIGO (The International Federation of Gynecology and Obstetrics) surgical staging should be performed. Patients not having primary surgery should be staged based on a clinical examination limited to the following methods: inspection, colposcopy, palpation under general anesthesia, biopsy, cystoscopy, rectoscopy, chest X-ray, bone X-ray, and urography. 

If the stage is uncertain, the lowest alternative should be chosen.

Findings on MRI, CT, and ultrasound may affect the choice of treatment, but should not change the stage.

Staging according to FIGO 

Stage I

Tumor is confined to the vulva. 

  • Ia: Lesion ≤ 2 cm in size. Confined to the vulva or perineum and with stromal invasion ≤ 1.0 mm* without inguinal lymph node metastasis.
  • Ib: Lesion > 2 cm in size or stromal invasion >1.0 mm* confined to the vulva or peritoneum without inguinal lymph node metastasis. 

*Infiltration depth is defined as the length from the tumor's epithelial-stromal connection point with the closest dermal papilla to the deepest point of infiltration.

  Vulva Stadium Ia & Ib

Stage II

Tumor regardless of size extending to adjacent perianal structures (outer third of urethra, outer third of vagina, anus) and without inguinal lymph node metastasis. 


Stage III

Tumor regardless of size, with or without invasion of adjacent perianal structures (outer third of urethra, outer third of vagina, anus) with inguinal lymph node metastases. 

  • IIIa: With (i) 1 lymph node metastasis (≥ 5 mm) or (ii) 1–2 lymph node metastases (< 5 mm)
  • IIIb: With (i) 2 or more lymph node metastases (≥ 5 mm) or (ii) 3 or more lymph node metastases (< 5 mm)
  • IIIc: With positive lymph nodes with extracapsular spreading.  


Stage IV

Tumor infiltrates other regional neightboring organs (2/3 proximal urethra, 2/3 proximal vagina) or distant metastasis.

  • IVa: Tumor infiltrates any of the following: (i) proximal urethra and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to the pelvic bone or (ii) fixed or ulcerating inguinal metastases. 
  • IVb: Any distant metastasis including pelvic node metastases.



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