© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancers.
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 are a type of white blood cell that has a major regulatory role in the immune system. CD4 lymphocytes are infected with and destroyed by HIV.
- The spread of the disease or the presence of HIV/AIDS-related systemic (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)
Only located on the skin and/or in the lymph nodes and/or minimal oral disease (flat lesions located only on the palate or roof of the mouth)
Tumor-associated edema (fluid buildup) or ulceration (break in the surface of the skin)
Extensive oral (mouth) 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 (Note: “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 [see below] 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.)
A Karnofsky performance status of less than 70
Other HIV-related illness is present (for example, 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)
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 extralymphatic organ (organ outside of the lymph node system) or site (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 its regional lymph nodes (lymph nodes near the site of the cancer), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).
Stage III: There is cancer in lymph node areas on both sides of the diaphragm (stage III). There may also be involvement of an organ other than the lymph nodes (stage IIIE); the spleen, using the letter “S” (stage IIIS); or both (stage IIIES).
Stage IV: Lymphoma is called stage IV if it has spread throughout the organs beyond the lymph nodes. Common sites for spread are the liver, bone marrow, or lungs.
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 comes 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.
The staging of HIV/AIDS-related cervical cancer is the same system used for women with cervical cancer who do not have HIV. The system judges three factors: 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 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.
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.