A lymphoma's stage tells you how much and where the cancer is in the body when it is first diagnosed. Along with the type of non-Hodgkin lymphoma (NHL), the stage is important in determining the treatment options and prognosis (outlook) for a child or teen with NHL.
The stage is based on the results of physical exams, biopsies, and imaging tests (CT scan, PET scan, etc.), which are described in Tests for Non-Hodgkin Lymphoma in Children.
A staging system describes how far a cancer has spread in a standard way. The system most often used to describe the spread of NHL in children is the International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS), which is a modified version of the older St. Jude staging system. This system is different from the one used for lymphomas in adults.
The IPNHLSS divides childhood NHL into 4 stages:
The lymphoma is in only 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 (belly).
Stage II lymphomas are not in the chest, and one of the following applies:
For stage III lymphomas, one of the following applies:
The lymphoma is in the central nervous system (brain or spinal cord) and/or the bone marrow when it is first found. (If more than 25% of the bone marrow is made up of cancer cells, called blasts, the cancer is classified as acute lymphoblastic leukemia [ALL] instead of lymphoma.)
Lymphoma staging can be confusing. If you are unsure about what it means for your child, ask your child’s doctor to explain it to you.
Along with the stage of the lymphoma (and the type of lymphoma), some other factors can also affect a child’s outlook (prognosis). These include:
If you have questions about what these prognostic factors might mean for your child, ask your child’s doctor to explain them to you.
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Gross TG, Kamdar KY, Bollard CM. Chapter 19: Malignant Non-Hodgkin Lymphomas in Children. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Principles and Practice of Pediatric Oncology. 8th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2021.
Link MP, Jaffe ES, Leonard JP. Pediatric Hodgkin and non-Hodgkin lymphomas. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:959-965.
Rosolen A, Perkins SL, Pinkerton CR, et al. Revised International Pediatric Non-Hodgkin Lymphoma Staging System. J Clin Oncol. 2015;33(18):2112-2118.
Sandlund JT, Onciu M. Chapter 94: Childhood Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Termuhlen AM, Gross TG. Overview of non-Hodgkin lymphoma in children and adolescents. UpToDate. 2021. Accessed at https://www.uptodate.com/contents/overview-of-non-hodgkin-lymphoma-in-children-and-adolescents on June 10, 2021.
Last Revised: August 10, 2021