HIV/AIDS-Related Cancer: Stages

Approved by the Cancer.Net Editorial Board, 07/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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.

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:

  • Tumor (T): The size of the tumor.

  • Immune system (I): 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.

  • Systemic illness (S): The spread of the disease throughout the body or the presence of HIV/AIDS-related systemic illness.

Within each of the 3 parts of the system, there are 2 subgroups: good risk (0, zero) or poor risk (1).

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

 

 

Good Risk (0)  
(Any of the following) 

Poor Risk (1)
(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

Non-Hodgkin lymphoma

Generally, people with HIV/AIDS-related non-Hodgkin lymphoma have advanced disease when they are first diagnosed. In this case, 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 4 stages: stages I through IV (1 through 4).

Stage I: Either of these conditions applies:

  • The cancer is found in 1 lymph node region (stage I).
  • The cancer has invaded 1 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 of these conditions:

  • The cancer is in 2 or more lymph node regions on the same side of the diaphragm (stage II).
  • The cancer involves 1 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-IV is now considered 1 category because they have the same treatment and prognosis.

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 the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Cervical cancer

The staging of HIV/AIDS-related cervical cancer follows the same system used for women with cervical cancer who do not have HIV. For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique or FIGO) is used.

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. This stage may be described in more detail (see below).

  • Stage IA: The cancer is diagnosed only by microscopy, which is viewing cervical tissue or cells under a microscope. No lymph nodes are involved, and there is no distant spread.
  • Stage IA1: There is a cancerous area of 3 millimeters (mm) or smaller in depth and 7 mm or smaller in length. No lymph nodes are involved, and there is no distant spread.
  • Stage IA2: There is a cancerous area larger than 3 mm but not larger than 5 mm in depth and 7 mm or smaller in length. No lymph nodes are involved, and there is no distant spread.
  • Stage IB: In this stage, the doctor can see the lesion, and the cancer is found only in the cervix. Or there is a lesion that can be seen using a microscope, and it is larger than a IA2 tumor (see above). The cancer may have been found through a physical examination, laparoscopy, or other imaging method (see Diagnosis). No lymph nodes are involved, and there is no distant spread.
  • Stage IB1: The tumor is 4 centimeters (cm) or smaller. No lymph nodes are involved, and there is no distant spread.
  • Stage IB2: The tumor is larger than 4 cm. No lymph nodes are involved, and there is no distant spread.

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. This stage may be described in more detail (see below).

  • Stage IIA: The tumor has not spread to the tissue next to the cervix, also called the parametrial area. No lymph nodes are involved, and there is no distant spread.
  • Stage IIA1: The tumor is 4 cm or smaller. No lymph nodes are involved, and there is no distant spread.
  • Stage IIA2: The tumor is larger than 4 cm. No lymph nodes are involved, and there is no distant spread.
  • Stage IIB: The tumor has spread to the parametrial area. No lymph nodes are involved, and there is no distant spread.

Stage III: The tumor has spread to the pelvic wall, and/or involves the lower third of the vagina, and/or causes swelling of the kidney, called hydronephrosis, or stops a kidney from functioning. No lymph nodes are involved, and there is no distant spread.

  • Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall. No lymph nodes are involved, and there is no distant spread.

  • Stage IIIB: The tumor has grown into the pelvic wall and/or affects the kidneys, but it has not spread to the lymph nodes or distant sites. Or, the cancer has spread to lymph nodes in the pelvis, but not distant sites, and the tumor can be any size.

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 the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Learn more about cervical cancer staging.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.