Your gift is 100% tax deductible.
Non-Hodgkin Lymphoma Stages
If you are diagnosed with non-Hodgkin lymphoma (NHL), your cancer care team will try to figure out if it has spread, and if so, how far. This process is called staging.
The stage of a lymphoma describes how much cancer is in the body. It helps determine how serious the lymphoma is and how best to treat it.
For many types of cancer, the stage is one of the most important factors in planning treatment. This is especially true when surgery is the main treatment. Lymphoma is different. It is rarely treated with surgery, and the type of lymphoma often matters more than the stage.
For example, many lymphomas can be cured even at stage IV, while some slow-growing lymphomas usually cannot be cured even when they are found at stage I. Still, the stage gives your care team useful information about how much the lymphoma has spread. It can affect which treatment is best for you.
The staging system described here is used to stage all types of non-Hodgkin lymphoma except for some small lymphocytic lymphomas (SLL).
If SLL is in the blood or bone marrow, it is often staged with the systems used for chronic lymphocytic leukemia (CLL). See Chronic Lymphocytic Leukemia Stages.
How is non-Hodgkin lymphoma staged?
The stage of a non-Hodgkin lymphoma is based on information gathered from tests such as:
- Physical exams
- 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 (also called a spinal tap, not always done)
In general, PET/CT scans are the most important tool for staging lymphomas that are FDG-avid.
If a lymphoma is FDG-avid, this means it takes up a radioactive sugar tracer called FDG that helps it show up clearly on the scan. Diffuse large B-cell lymphoma and follicular lymphoma are two examples of FDG-avid lymphomas.
PET/CT is less reliable or less commonly used for staging some other lymphoma types, such as marginal zone lymphoma and CLL/SLL. Bone marrow biopsy remains an important part of staging for these cancers.
Stages of non-Hodgkin lymphoma
The current staging system for NHL in adults is known as the Lugano classification, which is a modified version of the older Ann Arbor system.
How to read this information
- Stage number: NHL has 4 stages, labeled I, II, III, and IV.
- Letter E: For limited-stage lymphomas (stage I or II), the letter E is added to the stage if the cancer affects an organ outside the lymph system (an extranodal organ). For example, stage IE or IIE.
Either of the following means the disease is stage I:
- The lymphoma is in only 1 lymph node area or 1 lymphoid organ, such as the tonsils (I).
- The cancer is found in only 1 area of a single organ outside 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 the diaphragm* (above or below). For example, this might include nodes in the underarm and neck area but not a combination of underarm and groin nodes. This combination would be stage III.
- The lymphoma is in a group of lymph nodes and in 1 area of a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.
*The diaphragm is the thin band of muscle that separates the chest and abdomen.
Either of the following means the disease is stage III:
- The lymphoma is in lymph node areas on both sides of the diaphragm* (above and below).
- The lymphoma is in lymph nodes above the diaphragm and it is in the spleen.
*The diaphragm is the thin band of muscle that separates the chest and abdomen.
The lymphoma has spread widely into at least one organ outside the lymph system, such as the bone marrow, liver, or lungs.
What is bulky disease?
Bulky disease refers to a larger tumor mass. It is generally defined by the size of a tumor mass in its longest diameter.
How staging affects treatment
The stage of your lymphoma can help your care team choose the best treatment. But stage matters more for some types of lymphoma than for others. For most types, stage alone does not reflect whether the lymphoma can be cured.
For many of the more common types of NHL, the stage of the lymphoma does help doctors decide the amount of treatment you need and how intense the treatment should be. Your treatment will depend, in part, on whether your lymphoma is limited (stage I or II) or advanced (stage III or IV).
Some types of lymphoma are almost always widespread when they are found. Even if scans don't show it clearly, doctors assume these lymphomas have spread throughout the body. For these types, stage matters less when deciding on treatment.
For more on this, see:
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Almaimani J, Tsoumpas C, Feltbower R, Polycarpou I. FDG PET/CT versus bone marrow biopsy for diagnosis of bone marrow involvement in non-Hodgkin lymphoma: a systematic review. Appl Sci. 2022;12(2):540.
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(27):3059–3068.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: B-cell Lymphomas. Version 3.2026. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf on May 4, 2026.
Wierda WG, Brown J, Abramson JS, Awan F, Bilgrami SF, Bociek G, Brander D, Chanan-Khan AA, Coutre SE, Davis RS, Eradat H. NCCN Guidelines® insights: Chronic lymphocytic leukemia/small Lymphocytic lymphoma, version 3.2022: Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2022;20(6):622-634.
Last Revised: October 12, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
American Cancer Society Emails
Sign up to stay up-to-date with news, valuable information, and ways to get involved with the American Cancer Society.
