Non-Hodgkin Lymphoma Overview

+ -Text Size

Early Detection, Diagnosis, and Staging TOPICS

Staging of non-Hodgkin lymphoma

Staging is the process of finding out how far the cancer has spread. This is very important because the treatment and the patient's outlook for survival depend on the exact type, location, and stage of the cancer.

Tests used to gather information for staging

  • Physical exam
  • Biopsies
  • 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)

Ann Arbor staging system

A staging system is a way for members of the cancer care team to sum up the extent of a cancer’s spread. The Ann Arbor staging system is the one most often used for non-Hodgkin lymphoma (NHL). The stages are described by Roman numerals I through IV (1 through 4). As a rule, the higher the number, the more advanced the cancer. Letters can be added after the number based on certain factors:

  • If the lymphoma affects a single organ or tissue outside of the lymph system (for example, a bone) the letter E is added (for example, stage IIE)
  • The letter S is added if the lymphoma affects the spleen
  • The letter B is added if a person has any B symptoms (fever, night, sweats, or weight loss). If no B symptoms are present, the letter A is added instead.

The letter X is added if there is “bulky disease” meaning either the lymphoma in the chest is at least one-third as wide as the chest, or tumors in other places that are at least 4 inches across. For more details about this staging system, see “How is non-Hodgkin lymphoma staged” in our document Non-Hodgkin Lymphoma.

The type and stage of the lymphoma give useful information about a person's outlook. But for some types of lymphomas (such as fast-growing ones) knowing the stage is not too helpful on its own. In these patients, other factors can give doctors a better idea about their outlook (prognosis).

Other factors that affect prognosis (outlook) for non-Hodgkin lymphoma

The prognosis (outlook) for people with lymphoma can vary widely, depending on both the type and stage of the lymphoma. For some types of lymphomas, knowing the stage is not very helpful on its own. In these cases, other factors can give doctors a better idea about a person's outlook. Some of these other factors include:

  • The person's age
  • Whether or not the lymphoma is in organs outside the lymph system
  • How well a person can complete normal daily activities
  • The results of certain lab tests

For some types of lymphoma, these factors are combined into a prognostic index, which gives the doctor an overall idea of a person's likely prognosis and whether more intense treatment might be needed. To learn more about survival rates for different types of NHL, please see our document Non-Hodgkin Lymphoma.

Keep in mind that every person's situation is unique and these factors can't predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best.


Last Medical Review: 08/27/2014
Last Revised: 10/01/2014