Review of the current surgical management of vulval cancer

Table 1 Staging system for vulvar cancer of the international federation of gynaecology and obstetrics

IA	Tumour confined to the vulva or perineum, ≤ 2 cm in size with stromal invasion ≤ 1 mm, negative nodes
IB	Tumour confined to the vulva or perineum, > 2 cm in size or with stromal invasion > 1 mm, negative nodes
II	Tumour of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes
IIIA	Tumour of any size with positive inguino-femoral lymph nodes
	(1) 1 lymph node metastasis greater than or equal to 5 mm
	(2) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB	(1) 2 or more lymph nodes metastases greater than or equal to 5 mm
	(2) 3 or more lymph nodes metastases less than 5 mm
IIIC	Positive node(s) with extracapsular spread
IVA	(1) Tumour invades other regional structures (2/3 upper urethra, 2/3 upper
	vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
	(2) Fixed or ulcerated inguino-femoral lymph nodes
IVB	Any distant metastasis including pelvic lymph nodes

Table 2 Correlation between depth of invasion and nodal metastasis in vulval SCC

Depth of invasion	Percentage of positive nodes
< 1 mm	0%
1-2 mm	7.6%
2-3 mm	8.4%
3-5 mm	26.7%
> 5 mm	34.2%