Stages and grades for vaginal cancer

The stage of vaginal cancer tells you about its size and whether it has spread. The grade tells you how abnormal the cells look under the microscope. This helps your doctor decide which treatment you need.

Different staging systems for vaginal cancer

There are different ways of staging vaginal cancer. In the UK, doctors usually use the International Federation of Gynaecology and Obstetrics (FIGO) number staging. 

There are 4 stages. Stage 1 is the earliest stage and stage 4 is the most advanced stage.

Doctors may also use the TNM staging system. TNM stands for Tumour, Node, Metastasis:

• T describes the size of the tumour (cancer
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

Stage 1

Stage 1 vaginal cancer means that the cancer has started to grow into the wall of the vagina but has not spread further.

This stage is divided into 2 groups.

Stage 1A means the cancer is only in the vagina, it is not bigger than 2cm and has not spread to lymph nodes close to the vagina.

Stage 1B means the cancer is in the vagina only, it is bigger than 2cm but has not spread to lymph nodes close to the vagina. 

Stage 2

This stage is divided into 2 groups. 

Stage 2 A means the cancer has spread outside the vagina into the surrounding tissues, but it has not reached the walls of the pelvis or nearby lymph nodes. The cancer is not bigger than 2cm.

Stage 2B means the cancer has spread outside the vagina into the surrounding tissues, but it has not reached the walls of the pelvis or nearby lymph nodes. The cancer is bigger than 2cm.

Stage 3

This means that the cancer has spread outside the vagina and reached the side walls of the pelvis. This might cause problems when you are having a wee, for example, pain when weeing or blood in your wee. There may also be cancer cells in lymph nodes close to the vagina.

Stage 4

This stage is advanced vaginal cancer. This means that the cancer has spread to other body organs outside the vagina.

Stage 4 is divided into 2 groups. 

Stage 4A is when the cancer has spread to your bladder or back passage (rectum). 

Stage 4B is when the cancer has spread to organs further away, such as the lungs or the bones.

Grading of your cancer

Grading is a way of dividing cancer cells into groups depending on how much the cells look like normal cells. This gives your doctor an idea of how quickly or slowly the cancer might grow and whether it is likely to spread.

Grade 1

The cells look very like normal cells. They are also called low grade or well differentiated. They tend to be slow growing and are less likely to spread than higher grade cancer cells.

Grade 2

The cells look more abnormal and are more likely to spread. This grade is also called moderately differentiated or moderate grade.

Grade 3

The cells look very abnormal and not like normal cells. They tend to grow quickly and are more likely to spread. They are called poorly differentiated or high grade.

Treatment by stage

The treatment that is best for you will depend on:

• the type of vaginal cancer you have

• how far it has grown or spread (the stage)

• where the cancer is in your vagina

• any previous treatment you might have had

• whether the cancer has spread to another part of the body (this spread is also called secondary cancer or metastases)

• your general health and level of fitness

Treatment for stage 1 vaginal cancer

Radiotherapy

Radiotherapy is often the first treatment you have for stage 1 vaginal cancer. There are 2 different ways of having radiotherapy, external radiotherapy and internal radiotherapy (brachytherapy).In some situations you may have both. 

External beam radiotherapy directs radiation at a cancer from a machine outside of the body. Internal radiotherapy uses a radioactive source or an implant that is placed inside the vagina.

You usually have internal radiotherapy to treat small tumours on the inner lining of the vagina. You might have external radiotherapy as well as internal treatment if the cancer is in the deeper vaginal tissues.

Surgery

You might have surgery to treat stage 1 vaginal cancer. 

For a small stage 1 cancer in the lower part of the vagina, you might have surgery to remove the cancer and a border of healthy cells around the abnormal area (wide local excision).

You might need to have the whole of the vagina removed if the cancer is:

• in the lower part of the vaginal and not suitable for a wide local excision or
• in the middle part of your vagina.

This is a total vaginectomy. Your surgeon may then surgically make a new vagina for you, this is called a vaginal reconstruction.

If the cancer is in the upper part of your vagina, you have an operation to remove all of the vagina or part of the vagina (a partial vaginectomy). Your doctor will also need to remove the womb. This is a radical hysterectomy. 

After surgery you may have external radiotherapy.

Lymph nodes

The lymph nodes around the vagina in the groin and pelvis are often treated with external beam radiation therapy. Or it may be necessary to remove some or all of these lymph nodes during your surgery. 

Treatment for stage 2, stage 3 and stage 4A vaginal cancer

Stage 2, 3 and 4A vaginal cancer are all treated in a similar way.

Radiotherapy

Radiotherapy is the main treatment. This might be internal radiotherapy or external radiotherapy. In some situations, you may have both. 

You may also have external radiation to treat lymph nodes in the groin or pelvis.

Chemotherapy

You might also have chemotherapy treatment alongside radiotherapy. This is chemoradiotherapy. The chemotherapy drugs help the radiotherapy work better.  

Surgery

Your doctor might recommend surgery instead of radiotherapy if you have had previous radiotherapy to the pelvis.

Your doctor may remove:

• the vagina (a total vaginectomy)
• removal of your womb, cervix, upper part of your vagina, and the surrounding tissues (radical hysterectomy)

You might have surgery called a pelvic exenteration if your cancer has come back after treatment and spread to surrounding tissue.

The surgeon removes:

• your womb
• your vagina
• lymph nodes
• other organs in the pelvis such as the bladder or part of the bowel

This is not suitable for everyone. Your surgeon will tell you more about this surgery and if it's suitable for you.

Treatment for stage 4B vaginal cancer (advanced)

This stage is not usually curable. But radiotherapy can relieve symptoms such as pain, swelling or bleeding. Your specialist may suggest chemotherapy if you are fit enough to have this treatment. 

Surgery is not a standard treatment for advanced vaginal cancer. But in some situations, you might have it to treat symptoms. This is palliative surgery. It can relieve your symptoms but won’t cure the cancer.