Cervical biopsies are mandatory to rule out carcinoma of the cervix. Carcinoma of the vulva should also be ruled out.

Stages are defined by the Federation Internationale de Gynecologie et d’Obstetrique (FIGO) and the American Joint Committee on Cancer’s (AJCC) TNM classification.[1] The definitions of the T categories correspond to the stages accepted by the FIGO and both systems are included for comparison.

TNM Definitions

TNM Categories/FIGO Stages

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis/ 0: Carcinoma in situ
• T1/I: Tumor confined to vagina
• T2/II: Tumor invades paravaginal tissues but not to pelvic wall*
• T3/III: Tumor extends to pelvic wall*
• T4/IVA: Tumor invades mucosa of the bladder or rectum and/or extends beyond the true pelvis (Bullous edema is not sufficient evidence to classify a tumor as T4.)

  *Pelvic wall is defined as muscle, facia, neurovascular structures, or skeletal portions of the bony pelvis.

Regional lymph nodes (N)

• NX: Regional nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1/IVB: Pelvic or inguinal lymph node metastasis

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1/IVB: Distant metastasis

AJCC Stage Groupings

Stage 0

• Tis, N0, M0

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T1, N1, M0
• T2, N1, M0
• T3, N0, M0
• T3, N1, M0

Stage IVA

• T4, any N, M0

Stage IVB

• Any T, any N, M1

References:

1. Vagina. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 251-257.