How Is Non-Hodgkin Lymphoma Staged in Children?

Once non-Hodgkin lymphoma (NHL) is diagnosed, tests are done to determine the stage (extent of spread) of the disease. A child’s treatment and prognosis (outlook) depend, to a large extent, on the lymphoma’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 How Are Non-Hodgkin Lymphomas Diagnosed in Children?

A staging system is a standard way for the cancer care team to sum up how far a cancer has spread. The staging system most often used to describe the spread of NHL 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 NHL in children into 4 stages. In general, stage I and II lymphomas are considered 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 alike.

Stage I

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

Stage II lymphomas are not in the chest, and one of the following applies:

• The lymphoma is a single tumor and is also in nearby lymph nodes in only one part of the body (the neck, groin, underarm, etc.).
• The lymphoma is more than one tumor and/or in more than one set of lymph nodes, all of which are either above or below the diaphragm (the thin 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. It might or might not have reached nearby lymph nodes.

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 (and may be elsewhere as well).
• 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 is 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 cancer cells, called blasts, the cancer is classified as acute lymphoblastic leukemia [ALL] instead of lymphoma.)