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Vaginal cancer

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Stages of vaginal cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for vaginal cancer is the International Federation of Gynecology and Obstetrics (FIGO) system. The TNM categories, which correspond to FIGO, may also be used.

The classification applies only to primary vaginal carcinoma. Melanoma and sarcoma of the vagina are not staged using these staging systems. Melanoma of the vagina is staged as a melanoma of the skin. Sarcoma of the vagina is staged as soft tissue sarcoma.

Staging of vaginal carcinoma

The FIGO stages are based on surgical staging.

The TNM stages are based on clinical or pathological classification or both.

TNM

TNM stands for tumour, nodes, and metastasis. TNM staging describes:

  • the size of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

TNM pathological classification

The pT and pN categories match the T and N categories.

  • Examination of 6 or more inguinal (groin) or pelvic lymph nodes is usually done.
  • If the lymph nodes are negative but the usual number of nodes is not examined, the classification is pN0. (FIGO considers these cases pNX.)

TNM clinical classification

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

Carcinoma in situ – The cancer is in the epitheliumepitheliumA thin layer of epithelial cells that makes up the outer surfaces of the body (the skin) and lines hollow organs, glands and all passages of the respiratory, digestive, reproductive and urinary systems. and is not invading underlying tissue.

T1

Tumour is limited to the vagina.

T2

Tumour invades tissue close to the vagina but not the pelvic wall.

T3

Tumour extends to the pelvic wall.

T4

Tumour invades the mucosa of the bladder or rectum or extends beyond the pelvis.

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Stage grouping for vaginal cancer

FIGO further groups the TNM data into the stages listed in the table below.

Stage 0 (Tis N0 M0) is not included in the FIGO system.

  • Stage 0 is also called vaginal intraepithelial neoplasia III (VAIN III) or carcinoma in situ.
  • The cancer cells are only in the epithelium (surface layer of cells lining the vagina) and have not extended into the deeper layers of the vagina.

FIGO staging – vaginal carcinoma
FIGO stageTNMExplanation

stage I

T1

N0

M0

The cancer has grown through the epithelium but not through the vagina. There is no spread to lymph nodes or distant sites.

stage II

T2

N0

M0

The cancer has spread to tissues next to the vagina but not to the wall of the pelvis. There is no spread to lymph nodes or distant sites.

stage III

T3

any N

M0

The cancer has spread to the wall of the pelvis. There may be spread to lymph nodes but not to distant sites.

T1–T3

N1

M0

The cancer is in the vagina or may have spread into the tissues next to the vagina or to the wall of the pelvis. There is spread to nearby lymph nodes but not to distant sites.

stage IVA

T4

any N

M0

The cancer has spread from the vagina to nearby organs such as the bladder or rectum. There may be spread to the lymph nodes but not to distant sites.

stage IVB

any T

any N

M1

The cancer has spread to distant organs such as the lungs.

Recurrent vaginal cancer

Recurrent vaginal cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic vaginal cancer).

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