The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body. Grading refers to the appearance of cancer cells when they are looked at under the microscope. The grade gives an idea of how quickly the cancer may develop. Knowing the extent of the cancer and the grade helps the doctors to decide on the most appropriate treatment.

A commonly used staging system is described below:

Stage 0 or carcinoma in situ This is very early cancer (some doctors describe it as pre-cancer). The cancer is found in the vulva only and is only in the surface of the skin.

Stage 1 Cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (perineum).The affected area is 2 cm (about 1 inch), or less, wide.

Stage 2 Cancer is found in the vulva and/or the perineum. The affected area is larger than 2 cm (1 inch).

Stage 3 Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum) and/or nearby lymph nodes.

Stage 4 The cancer has spread beyond the urethra, vagina and anus into the lining of the bladder or the bowel; or, it may have spread to the lymph nodes in the pelvis or to other parts of the body.

There are three grades; grade 1 (low-grade), grade 2 (moderate-grade) and grade 3 (high-grade).

• Low-grade means that the cancer cells look very much like the normal cells of the vulva. They usually grow slowly and are less likely to spread.
• Moderate-grade means the cells look more abnormal than low-grade cells but not as abnormal as high-grade cells.
• High-grade means the cells look very abnormal. They are likely to grow more quickly and are more likely to spread.