Cancer Reference Information
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Overview: Lymphoma, Non-Hodgkin Type
After the Tests: Staging

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