The new (version 9) American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging protocol for carcinoma of the vulva - Protocol overview of major changes

Sep 22, 2026

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The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for all cancer sites has been updated through a restructured curation and publishing process. The AJCC’s TNM staging data are now hosted on a new application programming interface, with subsequent site-specific updates released electronically as protocols. The carcinoma of the vulva protocol, AJCC version 9, is validated using the American College of Surgeons’ National Cancer Data Base. The article summarizes major changes aligned with 2021 FIGO staging, including revised depth of invasion measurement, a new T4 subcategory, redefined N subcategories, and expanded M subcategories adding clinical to all M groups.

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Introduction

Staging systems for gynecologic cancers

DOI: 10. 3322/caac.70104 ARTICLE The new (version 9) American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging protocol for carcinoma of the vulva Alexander B. Olawaiye MD 1 | Elliot A. Asare MD, MS2 | Ian S. Hagemann MD, PhD3 | Priya R. Bhosale MD, MBA4 | Stephanie Gaillard MD, PhD5 | Brian Rous MBBChir, PhD6 | Bunja Rungruang MD7 | Shitanshu Uppal MD, MBA8 | Gulisa Turashvili MD, PhD9 | Kaled M. Alektiar MD 10 | Jonathan A. Cosin MD11 | Uma Krishnamurti MD, PhD12 | Lee-may Chen MD 13 | Keiichi Fujiwara MD, PhD14 | Matthew A. Powell MD 15 | Mauricio A. Cuello MD, PhD16 | David G. Mutch MD 15 Correspondence Alexander B. Olawaiye, Obstetrics, Gynecology and Reproductive Sciences, Magee-Women’s Hospital, University of Pittsburgh, School of Medicine, 300 Halket Street, Pittsburgh, PA 15261, USA. Email: [olawaiyea@upmc.edu](olawaiyea@upmc.edu) Abstract The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for all cancer sites has been updated periodically as a published manual for many years. The last update of the manual version, the eighth edition AJCC Cancer Staging Manual, went into use on January 1, 2018. The AJCC has since restructured and updated its processes for curating, analyzing, and publishing updates to the TNM staging system. All AJCC staging-related data are now housed on its new application programming interface. Consequently, the subsequent AJCC TNM staging updates are now published electronically as protocols and are released by disease sites. The protocol for carcinoma of the vulva, AJCC version 9, is now published. The new TNM vulvar cancer staging was validated using the American College of Surgeons’ National Cancer Data Base. This article highlights the changes to the new AJCC TNM staging protocol for carcinoma of the vulva; these changes align with the 2021 International Federation for Gynecology and Obstetrics staging. The most important of the changes are: (1) a new method for depth of invasion measurement,(2) the addition of a new T subcategory—T4, (3) redefined N subcategories, and (4) an increased number of M subcategories with the addition of clinical to all M subcategories. KEYWORDS American Joint Committee on Cancer (AJCC), category changes, staging, version 9, vulva This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society. CA Cancer J Clin. 2026;e70104. [https://doi.org/10.3322/caac.70104](https://doi.org/10.3322/caac.70104) wi[leyonlinelibrary.com/journal/caac](leyonlinelibrary.com/journal/caac) 1 of 7 INTRODUCTION Vulvar cancer represents a relatively rare but significant component of global cancer burden, ranking 29th in incidence worldwide with an estimated 48,894 new cases and 18,868 deaths in 2022.1 In the United States, approximately 7130 new cases and 1750 deaths are expected in 2026, representing 0.7% of all cancers in women.2 Similar to other solid cancers, cancer care providers need to have a means to describe the extent of spread and prognosis of vulvar cancer across institutional, national, and international boundaries, and staging fulfils this purpose. STAGING SYSTEMS FOR GYNECOLOGIC CANCERS There are two staging systems for gynecologic cancers used by clinicians for evaluating prognosis and choosing among treatment options: the tumor-node-metastasis (TNM) system and the International Federation for Gynecology and Obstetrics (FIGO) system. The TNM system is produced by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer. The AJCC liaises with both FIGO and the International Union Against Cance

FAQs

What is the purpose of the AJCC TNM staging update for vulvar cancer in version 9?

It provides a high-level overview of major protocol changes and improves classification and prognostic assessment for vulvar malignancies, aligning closely with contemporary FIGO staging.

How does AJCC version 9 improve the staging of vulvar cancer?

Key updates include a new method for depth of invasion measurement, addition of the T4 subcategory, redefined N subcategories, and increased M subcategories with clinical added to all M subcategories.

How was the AJCC version 9 vulvar cancer staging protocol validated?

The new TNM vulvar cancer staging was validated using the American College of Surgeons’ National Cancer Data Base.

Sep 22, 2026

Uploaded by hdkawk