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Staging is the process of gathering information from exams and
diagnostic tests to determine how widespread a cancer is. The stage of
a cancer may help in deciding the best treatment, although this is less
so for skin lymphomas than for other types of cancer. The stage can
also help predict the patient's prognosis (outlook).
A staging system is a standard way to describe the extent of
cancer spread. The staging system for skin lymphomas was developed by
the World Health Organization with the European Organization for
Research and Treatment of Cancer. There are 2 different staging systems
- one for mycosis fungoides and Sezary syndrome and another for the
other skin lymphomas. These systems require a level of detail that can
be hard to understand. This information is provided to assist you in
talking with your doctor about your disease, its treatment, and
outlook. Please discuss any questions you have with your health care
team.
Mycosis fungoides (MF) and Sezary syndrome
Mycosis fungoides (MF) and Sezary syndrome are both staged
using a version of the TNM system:
T
is determined by how much of the skin is involved with lymphoma.
T1: skin lesions can
be patches, papules (raised bumps), and/or plaques, but the lesions
cover less than 10% of the skin surface.
T2: the patches,
papules, and/or plaques cover more than 10% of the skin surface.
T3: at least one of
the skin lesions is a tumor that is 1 cm or larger (a cm is less than
1/2 of an inch).
T4: the skin lesions
have spread, grown larger, and grown together to cover at least 80% of
the skin surface.
N
is for lymph nodes, with higher numbers meaning more serious
involvement with lymphoma.
N0: lymph nodes are
not enlarged and there are no abnormal cells in any of the lymph nodes
that are removed.
N1: lymph nodes are
enlarged but they look normal under the microscope.
N2: Lymph nodes are
not enlarged, but they look abnormal under the microscope and contain
lymphoma cells.
N3: Lymph nodes are
enlarged, look abnormal under the microscope; and contain lymphoma
cells.
NX: lymph nodes are
enlarged but haven't been removed to look at under the microscope.
M is
for the spread of the lymphoma (metastases).
M0: the lymphoma
cells have not spread outside the skin or lymph nodes.
M1: lymphoma cells
have spread to other organs or tissues, such as the liver or spleen.
B
is for blood involvement with lymphoma.
B0: less than 5% of
lymphocytes in the blood are Sezary cells.
B1: low numbers of
Sezary cells in the blood (more than in B0 but less than in B2).
B2: high number of
Sezary cells in the blood (at least 1000 cells per microliter).
The values for T, N, M, and B are combined
to determine the stage.
Stage IA:
T1, N0, M0, B0 or B1
There are no tumors. Skin lesions cover less than 10% of the skin
surface (T1), the lymph nodes are not enlarged and look normal under
the microscope (N0), lymphoma cells have not spread to other organs or
tissues (M0), and the number of Sezary cells in the blood is not high
(B0 or B1).
Stage IB: T2,
N0, M0, B0 or B1
There are no tumors. Skin lesions cover at least 10% of the skin
surface (T2), the lymph nodes are not enlarged and look normal under
the microscope (N0), lymphoma cells have not spread to other organs or
tissues (M0), and the number of Sezary cells in the blood is not high
(B0 or B1).
Stage II:
T1 or T2, N1 or N2, M0, B0 or B1
There are no tumors. Skin lesions can cover any amount of the skin
surface (T1 or T2), the lymph nodes are either enlarged but look normal
under the microscope (N1) or they are not enlarged but contain lymphoma
cells (N2), lymphoma cells have not spread to other organs or tissues
(M0), and the number of Sezary cells in the blood is not high (B0 or
B1).
Stage IIB:
T3, N0 or N1 or N2, M0, B0 or B1
At least one of the skin lesions is a tumor that is 1 cm or larger; the
lymph nodes are either normal (N0), enlarged but look normal under the
microscope (N1), or they are not enlarged but contain lymphoma cells
(N2); lymphoma cells have not spread to other organs or tissues (M0);
and the number of Sezary cells in the blood is not high (B0 or B1).
Stage III: T4,
N0 to N2, M0, B0 or B1
Skin lesions cover at least 80% of the skin surface; the lymph nodes
are either normal (N0), enlarged but look normal under the microscope
(N1), or they are not enlarged but contain lymphoma cells (N2);
lymphoma cells have not spread to other organs or tissues (M0); and the
number of Sezary cells in the blood is not high (B0 or B1).
Stage IIIA:
T4, N0 to N2, M0, B0
Skin lesions cover at least 80% of the skin surface; the lymph nodes
are either normal (N0), enlarged but look normal under the microscope
(N1), or they are not enlarged but contain lymphoma cells (N2);
lymphoma cells have not spread to other organs or tissues (M0); and
there are few (or no) Sezary cells in the blood (B0).
Stage IIIB: T4,
N0 to N2, M0, B1
Skin lesions cover at least 80% of the skin surface; the lymph nodes
are either normal (N0), enlarged but look normal under the microscope
(N1), or they are not enlarged but contain lymphoma cells (N2);
lymphoma cells have not spread to other organs or tissues (M0); and the
number of Sezary cells in the blood is low (B1).
Stage IVA1: any
T, N0 to N2, M0, B2
The number of Sezary cells in the blood is high (B2); the lymph nodes
are either normal (N0), enlarged but look normal under the microscope
(N1), or they are not enlarged but contain lymphoma cells (N2);
lymphoma cells have not spread to other organs or tissues (M0); skin
lesions may be present in any amount or type.
Stage IVA2:
any T, N3, M0, any B
Lymph nodes are enlarged, look abnormal under the microscope; and
contain lymphoma cells (N3) but lymphoma cells have not spread to other
organs or tissues (M0). Skin lesions may be present in any amount or
type and Sezary cells may be present in the blood in any amount.
Stage IVB:
any T, any N, M1, any B
Lymphoma cells have spread to other organs or tissues.
Staging for other skin lymphomas
The following staging applies to any type of skin lymphoma
besides mycosis fungoides and Sezary syndrome. For these lymphomas,
only the T category is used at the time of diagnosis. If sites besides
the skin are involved at the time of diagnosis (such as lymph nodes),
these lymphomas are no longer considered skin lymphomas and they are
staged like regular non-Hodgkin lymphoma. The N and M categories are
only used if the lymphoma comes back after treatment.
T (for
tumor) is based on the amount of skin is involved with lymphoma.
T1: only a single
skin lesion
T1a: the skin lesion is
less than 5 cm (about 2 inches) across
T1b: the skin lesion is larger than 5 cm across
T2: 2 or more places
on the skin are involved with lymphoma; these places may be in a single
body region or in 2 body regions that are next to each other
T2a: all of the skin
lesions could be placed within a circle that is 15 cm (about 6 inches)
across
T2b: the circle needed to surround all of the skin lesions is larger
than 15 cm across, but smaller than 30 cm across
T2c: the circle needed to surround all of the skin lesions is larger
than 30 cm across
T3
T3a: many lesions
involving 2 body regions that aren't next to each other
T3b: many lesions involving 3 or more body regions
N is
for lymph nodes
N0: none of the
lymph nodes are enlarged or contain lymphoma cells
N1: there are
lymphoma cells in the lymph nodes that drain an area where skin
contained lymphoma
N2: Either
1) at least 2 sets of
lymph nodes contain lymphoma cells. These lymph nodes drain areas of
the skin that contained lymphoma; or
2) lymph nodes contain lymphoma cells that come from an area that
drains skin that has not been involved with lymphoma
N3: lymph nodes
inside the body (like the chest or abdomen) contain lymphoma cells
M
(for metastases) tells if the lymphoma has spread outside of the skin
or lymph nodes
M0: no signs of
lymphoma outside of the skin or lymph nodes
M1: lymphoma has
spread to other organs or tissues
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