Staging for Lymphoma in Children

Hodgkin lymphoma is stage I if:

• Hodgkin lymphoma is found in only 1 lymph node area or lymphoid organ (I).
• The cancer has spread from 1 group of nodes to another site nearby (IE).

Hodgkin lymphoma is stage II if:

• Hodgkin lymphoma is found in 2 or more lymph node areas on the same side of the diaphragm*, either above or below (II).
• The cancer involves an organ outside the lymph system and one or more lymph node regions on the same side of the diaphragm (IIE).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

Hodgkin lymphoma is stage III if:

• Hodgkin lymphoma is found in lymph node areas on both sides of the diaphragm*, above and below (III). These areas can include the spleen (IIIS), an organ outside the lymph system (IIIE), or both (IIISE).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

Hodgkin lymphoma has spread widely into at least one organ outside of the lymph system, such as the liver, bone, bone marrow, or lungs.

Other modifiers may also be used to describe the Hodgkin lymphoma stage.

Bulky disease (X)

Bulky disease is usually labeled by adding the letter X to the stage. It describes:

• Tumors in the chest that are at least ⅓ as wide as the chest, or
• Tumors in other areas that are larger than 6 centimeters across (10 centimeters for adults)

A or B

Each stage may also be assigned the letter A or B. For example: IIIB.

B is added if a child has any of these B symptoms:

• Unexplained weight loss of more than 10% of body weight over the previous 6 months
• Unexplained fever of at least 100.4°F (38°C) lasting for several days to weeks
• Drenching night sweats

If a child has any B symptoms, it usually means the lymphoma is more advanced and more intensive treatment is often recommended.

A is added to the stage if no B symptoms are present.

Either of the following means that the Hodgkin lymphoma is stage I:

• Hodgkin lymphoma is found in only 1 lymph node area or lymphoid organ, such as the thymus (I).
• The cancer is found only in 1 part of 1 organ outside the lymph system (IE).

Either of the following means that the Hodgkin lymphoma is stage II:

• Hodgkin lymphoma is found in 2 or more lymph node areas on the same side of the diaphragm*, either above or below (II).
• The cancer extends locally from 1 lymph node area into a nearby organ (IIE).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

Either of the following means that the Hodgkin lymphoma is stage III:

• Hodgkin lymphoma is found in lymph node areas on both sides of the diaphragm*, above and below (III). It may extend locally from a lymph node into a nearby organ (IIIE).
• Hodgkin lymphoma is in the spleen (IIIS).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

Hodgkin lymphoma has spread widely into at least one organ outside of the lymph system, such as the liver, bone marrow, or lungs.

Other modifiers may also be used to describe the Hodgkin lymphoma stage.

Bulky disease (X)

Bulky disease is usually labeled by adding the letter X to the stage. It describes:

• Tumors in the chest that are at least ⅓ as wide as the chest, or
• Tumors in other areas that are larger than 10 centimeters (about 4 inches) across

This is especially important for stage II lymphomas, because bulky disease may require more intensive treatment.

A or B

Each stage may also be assigned the letter A or B. For example: IIIB.

B is added if a child has any of these B symptoms:

• Unexplained weight loss of more than 10% of body weight over the previous 6 months
• Unexplained fever of at least 100.4°F (38°C) lasting for several days to weeks
• Drenching night sweats

If a child has any B symptoms, it usually means the lymphoma is more advanced and more intensive treatment is often recommended.

A is added to the stage if no B symptoms are present.

The lymphoma is only in one place, either:

• A single tumor outside the lymph nodes or
• In the lymph nodes in one part of the body excluding the chest or abdomen (belly)

The lymphoma has any of the following characteristics:

• The lymphoma is found in a single tumor with surrounding lymph nodes involved but no distant nodes.
• Lymphoma is in 2 or more areas of lymph nodes that are either all above or all below the diaphragm*, but not both. For example, you might have lymph nodes in the neck and underarm area.
• There are 2 separate tumors with or without surrounding lymph node involvement. The tumors are located either above or below the diaphragm, but not both.
• A tumor found in the digestive tract, usually in the intestines. The tumor can be completely removed with surgery. These tumors may have local lymph nodes involved.

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

The lymphoma has any of the following characteristics:

• There are 2 lymphoma tumors, one above and one below the diaphragm*.
• Lymphoma is in 2 or more areas of lymph nodes located both above and below the diaphragm.
• Tumors start in the chest, usually in the thymus, the lymph nodes in the center of the chest (mediastinum), or the lining of the lung (pleura).
• Tumors in the abdomen (belly) have spread throughout the belly and can’t be completely removed with surgery.
• The lymphoma includes a tumor near the spine or spinal cord covering (epidural).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

Stage IV lymphomas include stage I to III lymphomas which also have:

• Central nervous system involvement (brain and spinal cord) or
• Bone marrow involvement

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 (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:

• The lymphoma is a single tumor and is also in nearby lymph nodes in only one part of the body (neck, groin, underarm, etc.).
• The lymphoma is in more than one set of lymph nodes, all of which are either above or below the diaphragm*. 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.

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

One of the following applies:

• The lymphoma started in the chest, usually in the thymus, the lymph nodes in the center of the chest, or the lining of the lung.
• The lymphoma started in the abdomen (in organs like the liver, spleen, kidney, or ovary) or tumors of the digestive tract that cannot be removed completely with surgery and/or have spread outside the intestines. Any lymphoma of the belly where tumor cells are present in the abdominal fluid (ascites) is also considered stage III.
• The lymphoma includes a tumor near the spine or spinal cord covering (epidural).
• There are two or more tumors outside of the lymph nodes. These might be above or below the diaphragm* and could include tumors in the bones or skin.
• The lymphoma is in more than one set of lymph nodes above and below the diaphragm. For example, the lymphoma is in both underarm and groin lymph nodes.
• The lymphoma is a single tumor in a bone, and it is in a nearby area as well (either in or outside the lymph nodes).

*The diaphragm is the thin breathing muscle that separates the chest and abdomen.

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.