HIV and AIDS-Related Cancer: Stages

Approved by the Cancer.Net Editorial Board, 12/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which chance of recovery. There are different stage descriptions for different types of cancers.

Kaposi sarcoma

There is no officially accepted staging system for HIV/AIDS-related Kaposi sarcoma, although in 1988 the AIDS Clinical Trials Group (ACTG) developed a staging system called the TIS system. The ACTG is the largest HIV clinical trials organization in the world and is funded by the National Institutes of Health. The TIS system evaluates:

  • The size of the tumor (Tumor, T)
  • The status of the immune system, which is measured by the number of a type of white blood cell called a CD4 cell (Immune System, I). CD4 lymphocytes have a major regulatory role in the immune system and are infected with and destroyed by HIV.
  • The spread of the disease or the presence of HIV/AIDS-related systemic, or whole body, illness (Systemic Illness, S)

Within each of the three parts of the system, there are two subgroups: good risk (0, zero) or poor risk (1, one).

The following table has been adapted from the original developed by the ACTG to show the TIS system.

 

 

Good Risk (0)

Poor Risk (1)

 

(Any of the following)

(Any of the following)

Tumor (T)

Only located on the skin and/or in the lymph nodes and/or minimal oral disease, which are flat lesions located only on the palate or roof of the mouth

Tumor-associated fluid buildup, called edema, or ulceration

Extensive Kaposi sarcoma in the mouth, called oral Kaposi sarcoma

Gastrointestinal Kaposi sarcoma

Kaposi sarcoma in other organs in the body

Immune system (I)

CD4 cell count is 200 or more cells per cubic millimeter

CD4 cell count is less than 200 cells per cubic millimeter; a CD4 count lower than 200 indicates that HIV has developed into AIDS

Systemic illness (S)

No systemic illness present

History of systemic illness and/or thrush

No “B” symptoms. “B” symptoms are unexplained fever, night sweats, greater than 10% involuntary weight loss, or diarrhea persisting more than 2 weeks.

One or more “B” symptoms are present

A Karnofsky performance status score of 70 or higher. The Karnofsky Performance Status scale measures the ability of people with cancer to perform ordinary tasks. A score of 70 means that a person can take care of himself or herself, but is unable to carry on normal activity or active work. See below for more about the Karnofsky Performance Status scale.

A Karnofsky performance status of less than 70

Other HIV-related illness is present, such as neurological disease or lymphoma

Karnofsky Performance Score Function

100      Normal, no evidence of disease

90        Able to perform normal activity with only minor symptoms

80        Normal activity with effort, some symptoms

70        Able to care for self, but unable to do normal activities

60        Requires occasional assistance, cares for most needs

50        Requires considerable assistance

40        Disabled, requires special assistance

30        Severely disabled

20        Very sick, requires active supportive treatment

10        Moribund (dying; at the point of death)

0          Dead

Non-Hodgkin lymphoma

Generally, people with HIV/AIDS-related non-Hodgkin lymphoma have advanced disease when they are first diagnosed, and doctors use a staging system called the Ann Arbor system. This is the same system that is used for non-Hodgkin lymphoma in people who do not have HIV/AIDS.

The stage of lymphoma describes how much the tumor has spread. There are four stages: stages I through IV (one through four).

Stage I: Either one of these conditions:

  • The cancer is found in one lymph node region (stage I).
  • The cancer has invaded one organ outside of the lymph node system, which is called an extralymphatic organ, or site, which is identified using the letter “E”, but not any lymph node regions (stage IE).

Stage II: Either one of these conditions:

  • The cancer is in two or more lymph node regions on the same side of the diaphragm (stage II).
  • The cancer involves a single organ and the lymph nodes near the site of the cancer, called regional lymph nodes, with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III-IV: There is cancer in lymph node areas on both sides of the diaphragm (stage III), or the cancer has spread throughout the body beyond the lymph nodes (stage IV). Lymphoma most often spreads to the liver, bone marrow, or lungs. Stage III-IV lymphomas are common and are is still very treatable. Stage III and IV are now considered one category because treatment and prognosis do not differ between them.

Progressive: The disease is called progressive if the cancer becomes larger or spreads while the patient is receiving treatment for the original lymphoma. This is also called refractory NHL.

Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. It may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Cervical cancer

The staging of HIV/AIDS-related cervical cancer is the same system used for women with cervical cancer who do not have HIV. Doctors look at three factors to determine the stage of cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four).

Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the cervix, not in the deeper tissues. Carcinoma in situ is not considered an invasive cancer.

Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to lymph nodes or other parts of the body.

Stage II: The cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to lymph nodes or other parts of the body.

Stage III: The cancer has spread outside of the cervix and vagina but not to the lymph nodes or other parts of the body.

Stage IIIa: The cancer has spread to the lower part of the vagina but not to other parts of the body.

Stage IIIb: The cancer may have spread as far as the pelvic wall and to lymph nodes but not to other parts of the body. If it has spread to the pelvic wall, it is called stage IIIb regardless of whether there is cancer in the lymph nodes.

Stage IVa: The cancer has spread to the bladder or rectum and may or may not have spread to the lymph nodes, but it has not spread to other parts of the body.

Stage IVb: The cancer has spread to other parts of the body.

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the cervix or in another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Learn more about cervical cancer staging.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010), published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for HIV/AIDS-related cancers. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.