HIV/AIDS-Related Cancer: Stages

Approved by the Cancer.Net Editorial Board, 12/2019

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

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 treatment of HIV has changed a lot since 1988. Therefore, it is unclear if the TIS system is still clinically useful.

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 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 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 illness present

No “B” symptoms, which include unexplained fever, night sweats, greater than 10% involuntary weight loss, or diarrhea for more than 2 weeks

A Karnofsky Performance Status score of 70 or higher

History of systemic illness and/or thrush

One or more “B” symptoms are present

A Karnofsky performance status of less than 70

Other HIV-related illness is present, for example, neurological disease or lymphoma

Recurrent. Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Non-Hodgkin lymphoma

Generally, people with HIV/AIDS-related NHL 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 NHL 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, still very treatable, and often curable, depending on the NHL subtype. Stage III and stage IV are now considered a single category because they have the same treatment and prognosis.

Progressive/refractory: If the cancer grows larger or spreads while the patient is being treated for the original lymphoma, it is called progressive disease. This is also called refractory NHL.

Recurrent/relapsed: 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. This is also called relapsed NHL.

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.

Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to other parts of the body.

Staging is based on a the results of a physical exam, imaging scans, and biopsies.

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 other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail.

Stage II: The cancer has spread beyond the uterus 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 other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail.

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

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

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 Types of Treatment. Use the menu to choose a different section to read in this guide.