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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 and stage of the cancer.
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.
The letter "B" is added if the person has B symptoms (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.
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) the stage is not too helpful on its own. Other
factors, called prognostic factors, are looked at to get a better idea
of the person's outlook. These factors have proven useful for most
types of lymphoma.
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.
- a person's age
- the stage of the lymphoma
- whether or not it is in organs outside the lymph system
- how well a person can do normal daily activities (called
performance status or PS)
- the blood (serum) level of lactate dehydrogenase (LDH) --
this level goes up in the presence of fast-growing tumors
| Good
factors |
Poor
factors |
| Age 60 or below |
Age above 60 |
| Stage I or II |
Stage III or IV |
| No lymphoma outside of
lymph nodes, or only in one area outside of
lymph nodes |
Lymphoma found in more
than one 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 treatment was based only on the
type of lymphoma (the pathology report) and staging information.
For people with follicular lymphoma, a slightly different set
of prognostic factors is used. These are:
| Good
factors |
Poor
factors |
| Age 60 or below |
Age above 60 |
| Stage I or II |
Stage III or IV |
| Blood hemoglobin 12 g/dL
or above |
Blood hemoglobin below 12
g/dL |
| 4 or fewer lymph node
areas are involved |
More than 4 lymph node
areas are 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.
Last Medical Review: 08/06/2009
Last Revised: 08/06/2009
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