Non-Hodgkin Lymphoma Stages
What is the stage of a cancer?
The stage of a cancer is the extent of the disease at the time of diagnosis. The treatment and prognosis (outlook) for a patient with non-Hodgkin lymphoma (NHL) depend in part on the stage of the lymphoma.
Tests used to gather information for staging can include:
- Physical exam
- Biopsies of enlarged lymph nodes or other abnormal areas
- Blood tests
- Imaging tests, such as PET and CT scans
- Bone marrow aspiration and biopsy (often but not always done)
- Lumbar puncture (spinal tap – this may not need to be done)
In general, the results of imaging tests such as PET or CT scans are the most important when determining the stage of the lymphoma.
A staging system is a way for members of a cancer care team to sum up the extent of a cancer’s spread. The current staging system for NHL in adults is known as the Lugano classification, which is based on the older Ann Arbor system.
The stages are described by Roman numerals I through IV (1-4). Limited stage (I or II) lymphomas that affect an organ outside the lymph system (an extranodal organ) have an E added (for example, stage IIE).
Either of the following means the disease is stage I:
- The lymphoma is in only 1 lymph node area or lymphoid organ such as the tonsils (I).
- The cancer is found only in 1 area of a single organ outside of the lymph system (IE).
Either of the following means the disease is stage II:
- The lymphoma is in 2 or more groups of lymph nodes on the same side of (above or below) the diaphragm (the thin band of muscle that separates the chest and abdomen). For example, this might include nodes in the underarm and neck area but not the combination of underarm and groin nodes (II).
- The lymphoma is in a group of lymph node(s) and in one area of a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.
Either of the following means the disease is stage III:
- The lymphoma is in lymph node areas on both sides of (above and below) the diaphragm.
- The lymphoma is in lymph nodes above the diaphragm, as well as in the spleen.
The lymphoma has spread widely into at least one organ outside the lymph system, such as the bone marrow, liver, or lung.
This term is often used to describe large tumors in the chest. It is especially important for stage II lymphomas, as bulky disease might need more intensive treatment.
Staging small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL)
The system above is most often used to stage this lymphoma if it is only in lymph nodes. But if the disease is affecting the blood or bone marrow, it is often staged using the systems for CLL. See Chronic Lymphocytic Leukemia Stages.
How staging might affect treatment
The stage of a lymphoma is often important when determining a person’s treatment options, but it is more important for some types of lymphoma than for others. For many of the more common types of NHL, treatment is based in part on whether the lymphoma is “limited” (stage I or stage II non-bulky) or “advanced” (stage III or IV). For stage II bulky lymphomas, certain other factors (known as prognostic factors) are used to help determine if the lymphoma should be treated as limited or advanced.
For some other types of NHL, such as fast-growing lymphomas like Burkitt lymphoma, the stage is less important when deciding on treatment.
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification. J Clin Oncol. 2014;32:3059-3068.
Freedman AS, Jacobson CA, Mauch P, Aster JC. Chapter 103: Non-Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
National Cancer Institute. Physician Data Query (PDQ). Adult Non-Hodgkin Lymphoma Treatment. 2016. Accessed at www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq on May 15, 2016.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 3.2016. Accessed at www.nccn.org/professionals/physician_gls/pdf/nhl.pdf on May 11, 2016.
Roschewski MJ, Wilson WH. Chapter 106: Non-Hodgkin Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: May 31, 2016 Last Revised: May 31, 2016