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After someone is diagnosed with Kaposi sarcoma, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.
The results of the staging process are usually described in a standard way, using a staging system. Staging systems for most other types of cancer are based on the size of the primary tumor (the first one to develop) and how far the cancer has spread from there. But for people with AIDS-related Kaposi sarcoma (KS), the most common type in the United States, the outlook is influenced at least as much by the presence of other AIDS-related problems as it is by the spread of KS. For this reason, staging KS also considers factors such as how much the immune system is damaged and the presence of AIDS-related infections.
There is no officially accepted system for staging KS like there is for most other forms of cancer. But for AIDS-related KS, most doctors use the AIDS Clinical Trials Group system.
The AIDS Clinical Trials Group (ACTG) system for AIDS-related KS considers 3 factors:
Under each major heading, there are 2 subgroups: either a 0 (good risk) or a 1 (poor risk). The following are the possible staging groups under this system:
T0 (good risk): Localized tumor
KS is only in the skin and/or the lymph nodes (bean-sized collections of immune cells throughout the body), and/or there is only a small amount of disease on the palate (roof of the mouth). The KS lesions in the mouth are flat rather than raised.
T1 (poor risk): The KS lesions are widespread. One or more of the following is present:
The immune status is assessed using a blood test known as the CD4 count, which measures the number of white blood cells called helper T cells.
I0 (good risk): CD4 cell count is 150 or more cells per cubic millimeter (mm3).
I1 (poor risk): CD4 cell count is lower than 150 cells per mm3.
S0 (good risk): No systemic illness present; all of the following are true:
S1 (poor risk): Systemic illness present; one or more of the following is true:
Once these features have been evaluated, patients are assigned an overall risk group (either good risk or poor risk). In fact, since highly active antiretroviral therapy (HAART) became available to treat HIV, the immune status (I) has become less important and is often not counted in determining the risk group:
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Krown SE, Testa MA, Huang J. AIDS-related Kaposi’s sarcoma: Prospective validation of the AIDS Clinical Trials Group staging classification. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol. 1997;15:3085−3092.
Nasti G, Talamini R, Antinori A, et al. AIDS-related Kaposi’s sarcoma: Evaluation of potential new prognostic factors and assessment of the AIDS Clinical Trial Group Staging System in the HAART era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive From Antiretrovirals. J Clin Oncol. 2003;21:2876−2882.
National Comprehensive Cancer Network (NCCN)—AIDS-Related Kaposi Sarcoma. V1.2018 (11/03/2017). Accessed 03/02/2018 from https://www.nccn.org/professionals/physician_gls/pdf/kaposi.pdf.
Palmieri C, Dhillon T, Thirlwell C, et al. Pulmonary Kaposi sarcoma in the era of highly active antiretroviral therapy. HIV Med 2006;7:291–293
Yarchoan R, Uldrick TS, Polizzotto MN, Little RF. Ch. 117 - HIV-associated malignancies. In: DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2015.
Last Revised: April 19, 2018
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