© 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 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 cancer.
For epidemic Kaposi sarcoma, there is no official staging system; however, 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 specific type of white blood cell, called a CD4 cell, in the blood (Immune System, I)
- The spread of the disease or the presence of HIV/AIDS-related systemic 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 system, developed by the ACTG to illustrate the TIS system.
Good Risk (0)
Poor Risk (1)
(Any of the following)
(Any of the following)
|Tumor (T)||Only located in the skin and/or lymph nodes and/or minimal oral disease(flat lesions confined to 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|
|Systemic illness (S)||No systemic (throughout the body) 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 (see below)||A Karnofsky performance status of less than 70|
|Other HIV-related illness is present (for example, neurological disease or lymphoma)|
The Karnofsky Performance Status scale measures the ability of people with cancer to perform ordinary tasks. People with a score of at least 70 can take care of themselves but are unable to carry on normal activity or active work.
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)
Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.