Table 2.

Comparison between revised 2021 International Federation of Gynecology and Obstetrics (FIGO) and 2017 8th version of TNM staging vulvar cancer

Stage	Year	TNM	FIGO	FIGO (continued)	FIGO (continued)
Stage I	2009	I T1 N0M0	IA T1a N0M0	IB T1bN0M0
		Tumor confined to the vulva	IA: Tumor size ≤2 cm and stromal invasion ≤1 mm	IB: Tumor size >2 cm or stromal invasion >1 mm
Stage I	2021	Tumor confined to the vulva	IA: Tumor size ≤2 cm and stromal invasion ≤1 mm*	IB: Tumor size >2 cm or stromal invasion >1 mm*
Stage II	2009	II T2 N0 M0
		Tumor of any size with extension to the lower one-third of the urethra, lower one-third of vagina, anus with negative nodes
Stage II	2021	Tumor of any size with extension to the lower one-third of the urethra, lower one-third of vagina, anus with negative nodes
Stage III	2009	III T1-T2 N1-N2c M0	IIIA T1-T2 N1 M0	IIIB T1-2 N2a, N2b M0	IIIC T1-2 N2c M0
		Tumor of any size, with/without extension to adjacent perineal structures (lower third of urethra, the lower third of vagina, anus) with positive inguinofemoral lymph nodes	With one lymph node metastasis (≥5 mm) or 1–2 lymph node metastases (<5 mm)	With two or more lymph node metastases (≥5 mm) or three or more lymph node metastases (<5 mm)	With positive lymph nodes with extracapsular spread
Stage III	2021	III T3 (non-fixed to the bone) or N+ (non-ulcerated/non-fixed) M0	IIIA T1-T2 N+ (≤5 mm and no extracapsular spread) M0 T3 N0/N+ (≤5 mm and no extracapsular spread) M0	IIIB T1-3 N+ (>5 mm and no extracapsular spread) M0	IIIC T1-3 N+ (extracapsular spread) M0
		Tumor of any size with extension to upper part of adjacent perineal structures, or with any number of non-fixed, non-ulcerated lymph nodes	Tumor of any size with disease extension to upper two-thirds of the urethra, upper two-thirds of the vagina, bladder mucosa, rectal mucosa, or regional† lymph node metastases ≤5 mm	Regional† lymph node metastases >5 mm	Regional† lymph node metastases with extracapsular spread
Stage IV	2009	IV T1-T3 N3 M0-M1	IVA T1-T2 N3 M0 T3 any N M0	IVB Any T any N M1
		Tumor invades adjacent structures or fixed and ulcerated lymph nodes or distant metastases	Upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or is fixed to the pelvic bone. Fixed or ulcerated inguinofemoral lymph nodes	Any distant metastases, Including pelvic lymph nodes
Stage IV	2021	IV T3 (fixed to the bone) or N+ (ulcerated/fixed) or M1	IVA Any T N+ (fixed/ulcerated) M0 T3 (fixed to the bone) any N M0	IVB Any T any N M1
		Tumor of any size fixed to the bone, or fixed and ulcerated lymph node metastases, or distant metastases	Disease fixed to the pelvic bone,or fixed or ulcerated regional† lymph node metastases	Distant metastases

*Stromal invasion measured by new method; from the basement membrane of the deepest adjacent dysplatic (tumor-free) rete ridge to the deepest point of invasion.

†Inguinal and femoral lymph nodes.

M, metastasis; N, node; T, tumor.