Non-Hodgkin Lymphoma

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Early Detection, Diagnosis, and Staging TOPICS

How is non-Hodgkin lymphoma staged?

Once non-Hodgkin lymphoma is diagnosed, tests are done to determine the stage (extent of spread) of the disease. The treatment and prognosis (outlook) for a patient with non-Hodgkin lymphoma depend on both the exact type and the stage of the lymphoma.

Tests used to gather information for staging include:

  • Physical exam
  • Biopsies of enlarged lymph nodes or other abnormal areas
  • Blood tests
  • Imaging tests, such as CT scans
  • Bone marrow aspiration and biopsy (often but not always done)
  • Lumbar puncture (spinal tap – this may not need to be done)

These tests are described in the section “How is non-Hodgkin lymphoma diagnosed?

Ann Arbor staging system

A staging system is a way for members of the cancer care team to summarize the extent of a cancer’s spread. The staging system most often used to describe the extent of non-Hodgkin lymphoma in adults is called the Ann Arbor staging system.

The stages are described by Roman numerals I through IV (1-4). Lymphomas that affect an organ outside of the lymph system (an extranodal organ) have E added to their stage (for example, stage IIE), while those affecting the spleen have an S added.

Stage I

Either of the following means the disease is stage I:

  • The lymphoma is in only 1 lymph node area or lymphoid organ such as the thymus (I).
  • The cancer is found only in 1 area of a single organ outside of the lymph system (IE).

Stage II

Either of the following means the disease is stage II:

  • The lymphoma is in 2 or more groups of lymph nodes on the same side of (above or below) the diaphragm (the thin band of muscle that separates the chest and abdomen). For example, this might include nodes in the underarm and neck area but not the combination of underarm and groin nodes (II).
  • The lymphoma extends from a single group of lymph node(s) into a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.

Stage III

Either of the following means the disease is stage III:

  • The lymphoma is found in lymph node areas on both sides of (above and below) the diaphragm.
  • The cancer may also have spread into an area or organ next to the lymph nodes (IIIE), into the spleen (IIIS), or both (IIISE).

Stage IV

Either of the following means the disease is stage IV:

  • The lymphoma has spread outside of the lymph system into an organ that is not right next to an involved node.
  • The lymphoma has spread to the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs).

Other modifiers may also be used to describe the lymphoma stage:

Bulky disease

This term is used to describe tumors in the chest that are at least one-third as wide as the chest, or tumors in other areas that are at least 10 centimeters (about 4 inches) across. It is usually designated by adding the letter X to the stage. Bulky disease may require more intensive treatment.

A vs. B

Each stage may also be assigned an A or B. The letter B is added (stage IIIB, for example) if a person has any of the B symptoms listed below:

  • Loss of more than 10% of body weight over the previous 6 months (without dieting)
  • Unexplained fever of at least 101.5°F
  • Drenching night sweats

These symptoms usually mean the disease is more advanced. If a person has any of these, then more intensive treatment is usually recommended. If no B symptoms are present, the letter A is added to the stage.

Small lymphocytic lymphoma (SLL) /chronic lymphocytic leukemia (CLL)

The Ann Arbor system is most often used to stage this lymphoma if it is only in lymph nodes. But if the disease is affecting the blood or bone marrow, it is often staged using the systems for CLL. These systems are described in our document Leukemia – Chronic Lymphocytic, in the section “How is chronic lymphocytic leukemia staged?”


Last Medical Review: 03/27/2013
Last Revised: 11/14/2013