Tests Used to Gather Information for Staging

• the physical exam 
• blood tests 
• imaging tests (x-rays, CT scans, MRIs, etc.) 
• bone marrow aspiration and biopsy (often, but not always done) 
• lumbar puncture (spinal tap - this is not often done)

Ann Arbor Staging System

The staging system most often used for NHL is called the Ann Arbor staging system. The stages are described by Roman numerals I through IV (1 through 4). In general, the higher the number, the more serious the cancer. Lymphomas that affect organs outside of the lymph system have E added to their stage (for example, stage IIE), while those affecting the spleen have S added.

Stage I

• The lymphoma is in one lymph node or in nodes only in one region, such as the neck, groin, or underarm.

OR

• The cancer is found only in one area of a single organ outside of the lymph system (IE).

Stage II

• The lymphoma is in 2 or more groups of lymph nodes on the same side of (above or below) the diaphragm (the breathing muscle under the rib cage that separates the chest and abdomen). For example, this might be nodes in the underarm and neck area, but not the combination of underarm and groin nodes.
  

OR 

• 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

• The lymphoma is found in lymph node areas on both sides of (above and below) the diaphragm.

OR 

• The cancer may also have spread into an area or organ next to the lymph nodes (IIIE), into the spleen (IIIS), or both (IIIE, S).

Stage IV

• The lymphoma has spread outside of the lymph system into an organ that is not right next to an involved node.
  

OR

• The lymphoma has spread to the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs).

The letter "B" is added if the person has B symptoms such as weight loss, soaking night sweats, or high fever from no known cause. If the person does not have these symptoms the letter "A" is added.

Although the type and stage of the lymphoma give useful information about a person's outlook, for some types of lymphomas (such as fast-growing ones) the stage is not too helpful on its own. Other factors are looked at to help overcome this.

Prognostic Factors

An approach called the International Prognostic Index or IPI was put together to help predict how quickly a lymphoma might grow and how well a patient might respond to treatment. Five factors are used to point to a better or worse outcome.

Good factors	Poor factors
Age 60 or below	Age above 60
Stage I and II	Stage III or IV
No lymphoma outside of lymph nodes	Lymphoma found in more than 1 organ outside of lymph nodes
Patient able to function normally	Patient needs a lot of help with daily activities
Serum LDH* is normal	Serum LDH is high

*Serum LDH is a protein found in the blood. LDH goes up when there are fast growing tumors.

These factors are important because they allow doctors to plan treatment better than they could if they used only the pathology report and staging information.

For people with follicular lymphoma, a slightly different set of factors is used. These are:

Good factors	Poor factors
Age 60 or below	Age above 60
Stage I and II	Stage III or IV
Blood hemoglobin 12 or above	Blood hemoglobin below 12
4 or fewer lymph nodes involved	More than 4 lymph nodes involved
Serum LDH normal	Serum LDH is high

*Serum LDH is a protein found in the blood. LDH goes up when there are fast growing tumors.