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After someone is diagnosed with Non-Hodgkin Lymphoma, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. .
Tests used to gather information for staging can include:
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:
Either of the following means the disease is stage II:
Either of the following means the disease is stage III:
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.
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.
The stage of a lymphoma is 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.
See Treating B-cell Non-Hodgkin Lymphomas and Treating T-cell Non-Hodgkin Lymphomas for more on this.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
American Joint Committee on Cancer. Hodgkin and Non Hodgkin Lymphoma In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:937
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. 2018. Accessed at https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq#section/_1 on May 2, 2018.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: B-cell Lymphomas. Version 3.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf on May 2, 2018.
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 Revised: August 1, 2018
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