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Staging is the process of finding out how far a cancer has
spread. A child's treatment and prognosis (outlook) depend, to a large
extent, on the cancer's stage.
Staging is based on the results of the physical exam,
biopsies, and imaging tests (CT scan, PET scan, etc.), which are
described in the section, "How
are non-Hodgkin lymphomas in children diagnosed?"
A staging system is a standardized way for the cancer care
team to summarize information about how far a cancer has spread. The
staging system most often used to describe the spread of non-Hodgkin
lymphoma in children is called the St. Jude staging system. This is
different from the staging system used for lymphomas in adults (the Ann
Arbor staging system).
St. Jude staging system
The St. Jude system divides non-Hodgkin lymphoma in children
into 4 stages. In general, stage I and II lymphomas are considered to
be limited-stage disease and are treated the same way. Stage III and IV
lymphomas are usually thought of as advanced-stage disease and are also
treated similarly.
Stage I
The lymphoma is in one place, either as a single tumor not in lymph nodes or in lymph nodes
in one part of the body (the neck, groin, underarm, etc.). The lymphoma
is not in the chest or abdomen.
Stage II
Stage II lymphomas are not in the chest, and one of the
following applies:
- The lymphoma is a single tumor and is in nearby
lymph nodes in one part of the body (the neck, groin, underarm, etc.).
- The lymphoma is more than one tumor or in more than one set
of lymph nodes, all of which are either above or below the diaphragm
(the breathing muscle that separates the chest and abdomen). For
example, this might mean nodes in the underarm and neck area are
affected but not the combination of underarm and groin nodes.
- The lymphoma started in the digestive tract (usually at the
end of the small intestine) and can be removed by surgery. Nearby lymph
nodes may or may not be involved.
Stage III
For stage III lymphomas, one of the following applies:
- The lymphoma started in the chest (usually in the thymus or
lymph nodes in the center of the chest or the lining of the lung).
- The lymphoma started in the abdomen and has spread too
widely within the abdomen to be completely removed by surgery.
- The lymphoma is located next to the spine.
- The lymphoma is more than one tumor or in more than one set
of lymph nodes that are both above and below the diaphragm. For
example, the lymphoma may be in both underarm and groin lymph nodes.
Stage IV
The lymphoma is in the central nervous system (brain or spinal
cord) or the bone marrow when it is first found. (If more than 25% of
the bone marrow is abnormal cells, the cancer is classified as leukemia
instead of lymphoma.) Last Medical Review: 07/08/2009
Last Revised: 07/08/2009
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