Vulva, vagina & female urethra
General
Staging-vulva carcinoma


Topic Completed: 31 January 2019

Minor changes: 30 September 2020

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PubMed Search: Staging[TI] vulvar carcinoma

Carlos Parra-Herran, M.D.
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Cite this page: Parra-Herran C. Staging-vulva carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvastaging.html. Accessed October 20th, 2020.

Pathologic TNM staging of carcinoma of the vulva, AJCC 8th edition and FIGO 2018 update
Definition / general
  • Based on the American Joint Committee on Cancer (AJCC) Staging Manual (8th edition) and the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO) 2018 update
  • Includes tumors with primary site of growth in vulva only; excludes mucosal melanoma
  • Depth of invasion is defined as the measurement of the tumor from the epithelial stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion
  • AJCC / FIGO no longer uses Tis
  • Site and laterality of lymph node metastases should be described
  • Multifocality does not affect staging, although it is a prognostic factor; thus, multifocal lesions should be designated as such
    • Largest lesion or lesion with the greatest depth of invasion will determine the pT stage
Essential features
Primary tumor [pT] and FIGO () stage
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor
  • pT1 (I): tumor confined to the vulva or perineum
    • pT1a (IA): lesions ≤ 2 cm in size, confined to the vulva or perineum and with stromal invasion ≤ 1.0 mm
    • pT1b (IB): lesions > 2 cm in size or any size with stromal invasion > 1.0 mm, confined to the vulva or perineum
  • pT2 (II): tumor of any size with extension to adjacent perineal structures (lower / distal 1/3 of urethra, lower / distal 1/3 of vagina, anal involvement)
  • pT3 (IVA): tumor of any size with extension to any of the following: upper / proximal 2/3 of urethra, upper / proximal 2/3 of vagina, bladder mucosa, rectal mucosa or fixed to pelvic bone
Regional lymph nodes [pN] and FIGO () stage
  • pNX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
    • pN0(i+): isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
  • pN1 (IIIA): 1 or 2 regional lymph nodes with the following features:
    • pN1a (IIIA): 1 or 2 lymph node metastases < 5 mm **
    • pN1b (IIIA): 1 lymph node metastasis ≥ 5 mm
  • pN2 (IIIB): regional lymph node metastasis with the following features:
    • pN2a (IIIB): 3 or more lymph node metastases each < 5 mm **
    • pN2b (IIIB): 2 or more lymph node metastases ≥ 5 mm
    • pN2c (IIIC): lymph node metastasis with extracapsular spread
  • pN3 (IVA): fixed or ulcerated regional lymph node metastasis

** Includes micrometastases (N1mi and N2mi)
Distant metastasis [pM] and FIGO () stage
  • pM0: no distant metastasis
  • pM1 (IVB): distant metastasis (including pelvic lymph node metastasis)
Stage grouping
Stage 0: Tis N0 M0
Stage I: T1 N0 M0
Stage IA: T1a N0 M0
Stage IB: T1b N0 M0
Stage II: T2 N0 M0
Stage IIIA: T1 - 2 N1a - b M0
Stage IIIB: T1 - 2 N2a - b M0
Stage IIIC: T1 - 2 N2c M0
Stage IVA: T1 - 2 N3 M0
T3 any N M0
Stage IVB: any T any N M1
Board review style question #1
Which of the following statements is true regarding staging of carcinoma of the vulva?

  1. Depth of invasion is defined as the measurement of the tumor from the tumor surface to the deepest point of invasion
  2. Depth of invasion of > 1 mm, in a tumor confined to the vulva, qualifies as stage IB disease
  3. Multifocal lesions are by definition stage IB
  4. Size of metastatic tumor to lymph nodes and extranodal extent are not required for staging
Board review answer #1
B. Depth of invasion is a critical parameter for grading early stage vulvar cancer. > 1 mm of invasive depth qualifies as stage IB. Depth of invasion is defined as the measurement of tumor from the epithelial stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. Size of metastatic tumor to lymph nodes (< 5 mm versus ≥ 5 mm) and extranodal spread are required to subclassify nodal staging (N category in TNM, stage III in FIGO staging). Multifocality has prognostic implications but does not affect the staging.

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