Staging

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if 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.

Kaposi’s sarcoma

There is no officially accepted staging system for HIV/AIDS-related Kaposi’s 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 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 three-year relative survival rate (the percentage of people who survive at least three years after the cancer is detected, excluding those who die from other diseases) for people in the good-risk category in both the T and S factors is 90%. People in the poor-risk category in the T and S factors have a three-year relative survival rate of 50%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with HIV/AIDS-related Kaposi’s sarcoma. Because the survival statistics are measured in three-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

Source of statistics: American Cancer Society

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

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 at the time of diagnosis, 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 the extent of spread of the tumor. 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: Any of these conditions:

• There is cancer in lymph node areas on both sides of the diaphragm (stage III).
  
  
• There is involvement of an organ in the localized area (stage IIIE); involvement of the spleen, using the letter “S” (stage IIIS); or both (stage IIIES).

Stage IV: Lymphoma is called stage IV if there is a tumor in and organ outside of the lymph node system (called disseminated involvement). Common sites are the liver, bone marrow, or lungs.

Recurrent: Recurrent cancer is cancer that comes back after treatment.

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. For more information, read about cervical cancer staging.