Stage IV vulvar cancer is divided into stages IVA and IVB. In stage IVA, the cancer (1) has spread to nearby lymph nodes on both sides of the groin, or (2) has spread beyond nearby tissues to the upper part of the urethra, bladder, or rectum, or (3) is attached to the pelvic bone and may have spread to lymph nodes. In stage IVB, the cancer has spread to distant parts of the body.