Vulvar cancer TNM staging AJCC version 9

Primary tumor (T)^*
T category	FIGO stage	T criteria
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
T1	I	Tumor confined to the vulva
T1a	IA	Tumor size ≤2 cm in greatest dimension and stromal invasion ≤1 mm NOTE: Depth of invasion is measured from the basement membrane of the deepest adjacent tumor-free rete ridge to the deepest point of invasion.
T1b	IB	Tumor size >2 cm in greatest dimension or stromal invasion >1 mm NOTE: Depth of invasion is measured from the basement membrane of the deepest adjacent tumor-free rete ridge to the deepest point of invasion.
T2	II	Tumor of any size with extension to lower 1/3 of urethra, lower 1/3 of vagina, or anus
T3	IIIA	Tumor of any size with disease extension to upper 2/3 of urethra, upper 2/3 of vagina, bladder mucosa, rectal mucosa
T4	IVA	Tumor fixed to pelvic bone
Primary tumor suffix (m) Multiple synchronous primary tumors
Regional lymph nodes (N)^*
N category	FIGO stage	N criteria
NX		Regional lymph nodes cannot be assessed
N0		No regional lymph node metastasis
N0(i+)		Isolated tumor cells in regional lymph node(s) ≤0.2 mm, or single cells or clusters of cells ≤200 cells in a single lymph node cross-section
N1	III	Tumor involvement of non-fixed, non-ulcerated regional lymph nodes
N1mi	IIIA	Tumor involvement >0.2 mm but ≤2.0 mm in diameter of regional lymph nodes
N1a	IIIA	Tumor involvement >2.0 mm but ≤5 mm of regional lymph nodes
N1b	IIIB	Tumor involvement >5 mm of regional lymph nodes
N1c	IIIC	Tumor involvement of regional lymph nodes with extranodal extension (ENE)
N2	IVA	Tumor involvement of fixed or ulcerated regional lymph nodes
Regional lymph nodes suffix (sn) Sentinel node procedure (f) FNA or core needle biopsy
Distant metastasis (M)^*
M category	FIGO stage	M criteria
cM0		No distant metastasis
cM1	IVB	Distant metastasis
pM1	IVB	Microscopic confirmation of distant metastasis
AJCC prognostic stage group is assigned based on the stage classification and categories chosen.^*
Prognostic stage groups
When T is...	And N is...	And M is...	Then the stage group is...
T1	N0	M0	I
T1a	N0	M0	IA
T1b	N0	M0	IB
T2	N0	M0	II
TX-T3	N1	M0	III
T3	N0	M0	IIIA
TX-T3	N1mi, N1a	M0	IIIA
TX-T3	N1b	M0	IIIB
TX-T3	N1c	M0	IIIC
T4	Any N	M0	IVA
Any T	N2	M0	IVA
Any T	Any N	M1	IVB

AJCC: American Joint Committee on Cancer; FIGO: International Federation of Gynecology and Obstetrics; TNM: tumor, node, metastasis.

* AJCC data elements required for staging are identified with an asterisk.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging System, Version 9: Vulva (2023).

Graphic 144880 Version 2.0

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Vulvar cancer TNM staging AJCC version 9