VULVA (ICD‐O‐3 C51)

The definitions of the T, N, and M categories correspond to the FIGO stages. Both systems are included for comparison.

Rules for Classification

The classification applies only to primary carcinomas of the vulva. There should be histological confirmation of the disease.

A carcinoma of the vulva that has extended to the vagina is classified as carcinoma of the vulva.

The FIGO stages are based on surgical staging. TNM stages are based on clinical and/or pathological classification.

Anatomical Subsites (Fig. 405)

Labia majora (C51.0)
Labia minora (C51.1)
Clitoris (C51.2)

Schematic illustration of Labia majora, Labia minora and Clitoris. — **Fig. 405**

Regional Lymph Nodes

The regional lymph nodes are the inguinofemoral (groin) nodes.

TNM Clinical Classification

T – Primary Tumour

TX	Primary tumour cannot be assessed
T0	No evidence of primary tumour
Tis	Carcinoma in situ (preinvasive carcinoma), intraepithelial neoplasia grade III (VIN III)
T1	Tumour confined to vulva or vulva and perineum (Fig. 406c)
	T1a	Tumour 2 cm or less in greatest dimension and with stromal invasion no greater than 1.0 mm* (Fig. 406a)
	T1b	Tumour greater than 2 cm or with stromal invasion greater than 1 mm* (Fig. 406b)
T2	Tumour invades any of the following perineal structures: lower third urethra, lower third vagina, anus (Fig. 407)
T3**	Tumour invades any of the following perineal structures: upper 2/3 urethra, upper 2/3 vagina, bladder mucosa, rectal mucosa; or fixed to pelvic bone (Fig. 408)

Notes*
The depth of invasion is defined as the measurement of the tumour from the epithelial–stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion.

**T3 is not used by FIGO. They label it T4.

Schematic illustration of tumour 2 cm or less in greatest dimension and with stromal invasion no greater than 1.0 mm, Tumour greater than 2 cm or with stromal invasion greater than 1 mm, Tumour confined to vulva or vulva and perineum. — **Fig. 406**

Schematic illustration of tumour invades any of the following perineal structures: lower third urethra, lower third vagina, anus. — **Fig. 407**

Schematic illustration of tumour invades any of the following perineal structures: upper 2/3 urethra, upper 2/3 vagina, bladder mucosa, rectal mucosa; or fixed to pelvic bone. — **Fig. 408**

Schematic illustration of One or two lymph node metastasis less than 5 mm. — **Fig. 409**

Schematic illustration of One lymph node metastases 5 mm or greater. — **Fig. 410**

Schematic illustration of Three or more lymph node metastases each less than 5 mm. — **Fig. 411**

Schematic illustration of Two or more lymph node metastases 5 mm or greater. — **Fig. 412**

Schematic illustration of Fixed or ulcerated regional lymph node metastasis. — **Fig. 413**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis with the following features
	N1a	One or two lymph node metastasis less than 5 mm (Fig. 409)
	N1b	One lymph node metastases 5 mm or greater (Fig. 410)
N2	Regional lymph node metastasis with the following features:
	N2a	Three or more lymph node metastases each less than 5 mm (Fig. 411)
	N2b	Two or more lymph node metastases 5 mm or greater (Fig. 412)
	N2c	Lymph node metastasis with extracapsular spread
N3	Fixed or ulcerated regional lymph node metastasis (Fig. 413)

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis (including pelvic lymph node metastasis)

pTN Pathological Classification

The pT and pN categories correspond to the T and N categories.

pM1	Distant metastasis microscopically confirmed

Note
pM0 and pMX are not valid categories.

pN0

Histological examination of an inguinofemoral lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.