Staging is the process of finding out how far lymphoma has spread within the lymph system or to other parts of the body. This is very important because your treatment and prognosis (the outlook for your recovery) depend in large part on the stage of your cancer. Accurate staging allows doctors to choose the most appropriate therapy and can help you avoid ineffective therapy.
Stages of Hodgkin’s Lymphoma
The same tests doctors use to diagnose Hodgkin’s lymphoma are used to determine the type and stage. Hodgkin’s lymphomas are considered to be at one of four stages.
- Stage I: Lymphoma is in only one lymph-node area or one organ.
- Stage II: Lymphoma is in two or more lymph-node areas either above or below the diaphragm (the thin muscle below the lungs that separates the chest from the abdomen).
- Stage III: Lymphoma is in several lymph-node areas above and below the diaphragm.
- Stage IV: Lymphoma is widespread in the lymph nodes and other organs, such as the bone marrow, lungs, and liver.
Doctors may add a letter after your stage to describe more about your disease.
- A (such as “stage IA”) means you do not have symptoms.
- B (such as “stage IB”) means you have B symptoms: fever, weight loss, or night sweats.
- E (such as “stage IIIE”) means that your cancer is found in an organ or tissue that is not part of the lymph system but may be next to an involved area of the lymph system.
- S (such as “stage IIIS”) means the cancer is found in the spleen.
If lymphoma comes back after treatment, it is called recurrent or relapsed. Your doctor will order imaging or other tests to restage it.
Adult Hodgkin’s lymphoma may be grouped for treatment into four categories.
Early favorable Hodgkin’s lymphoma is stage I or stage II without any of the risk factors that define early unfavorable disease, listed below.
Early unfavorable Hodgkin’s lymphoma is stage I or stage II with one or more of these risk factors:
- A tumor in the chest larger than one-third the width of the chest or at least 10 centimeters
- Cancer in an organ other than the lymph nodes
- A high sedimentation rate in a sample of blood (meaning red blood cells settle quickly to the bottom of a test tube)
- Three or more lymph nodes with cancer
- Symptoms such as fever, weight loss, or night sweats
Advanced favorable Hodgkin’s lymphoma is stage III or stage IV with three or fewer of these risk factors:
- Being male
- Age 45 years or older
- Stage IV disease
- Low blood albumin (protein) level (below 4)
- Low hemoglobin level (below 10.5)
- High white blood cell count (15,000 or higher)
- Low lymphocyte count (below 600 or less than 8% of the white blood cell count)
Advanced unfavorable Hodgkin’s lymphoma is stage III or stage IV with four or more of the risk factors listed above under “advanced favorable.”