Alexander B Olawaiye, Elliot A Asare, Ian S Hagemann, Priya R Bhosale, Stephanie Gaillard, Brian Rous, Bunja Rungruang, Shitanshu Uppal, Gulisa Turashvili, Kaled M Alektiar, Jonathan A Cosin, Uma Krishnamurti, Lee-May Chen, Keiichi Fujiwara, Matthew A Powell, Mauricio A Cuello, David G Mutch
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.