Approach to staging vulvar cancer

Size of lesion	Depth of invasion (mm)	Location	Operation	Inguinofemoral lymphadenectomy or sentinel lymph node evaluation*^¶
T1a	≤1	Lateral^Δ or central	Radical local excision	No
T1a	>1	Lateral^Δ	Radical local excision	Ipsilateral
T1b	–	Central	Radical local excision	Bilateral
T1b	–	Lateral	Radical local excision	Ipsilateral
T2: Any size with extension to adjacent perineal structures (lower/distal 1/3 urethra, lower/distal 1/3 vagina, anal involvement)	–	–	Modified radical^◊ and/or chemoradiation	Bilateral
Extensive T3-T4 disease (upper/proximal 2/3 of urethra, upper/proximal 2/3 vagina, bladder mucosa, rectal mucosa, or fixed to pelvic bone)	–	–	Neoadjuvant chemoradiation^§ and selected surgery	–

* Many institutions also offer sentinel node biopsy to patients with a tumor diameter up to <4 cm.
¶ Bilateral lymphadenectomy is performed if unilateral node is positive.
Δ Further than 1 cm from midline.
◊ Modified radical vulvectomy (terminology includes radical hemivulvectomy, anterior or posterior modified radical vulvectomy).
§ Can consider chemoradiation as primary treatment or postoperative radiation for patients with high risk of local recurrence (those with stage IVA disease, positive or close margins, and a large number of groin nodes).

Graphic 87981 Version 5.0

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Approach to staging vulvar cancer