Stages of Hodgkin lymphoma

Staging describes how much lymphoma there is in the body and where it is when first diagnosed. This is often called the extent of lymphoma. Information from tests is used to find out the size of the tumour, whether the lymphoma has spread from where it first started and where the lymphoma has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for HL is the Lugano classification. It is based on an older system called the Ann Arbor system. There are 4 stages in the Lugano classification. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the lymphoma has spread.

The Lugano classification bases the stage of HL on the number of places in the lymphatic system where lymphoma is found. It considers the following lymphatic sites (also called nodal sites):

• lymph nodes
• the area of lymphatic tissues in the throat that includes the tonsils and the adenoid (called Waldeyer’s ring)
• the thymus
• the spleen

HL is staged by also looking at:

• if the lymphoma is found above, below or on both sides of the diaphragm
• if the lymphoma is found on the left, the right or both sides of the body
• if the lymphoma is found in an organ or tissues outside the lymphatic system, including in the liver, lungs or bones
• if you have B symptoms (fever, drenching night sweats and unexplained weight loss)
• the size, or bulk, of the tumour

The healthcare team may add the following letters to the stage number to give more information about the disease at the time of diagnosis.

A– You don’t have any B symptoms.

B– You have B symptoms.

E– The lymphoma is in nearby tissue outside of the lymphatic system (called an extranodal site).

S– The lymphoma is in the spleen.

Talk to your healthcare team if you have questions about staging.

Stage 1 HL is considered early (or limited) stage. Cancer is in only 1 lymphatic site.

• Stage 1A – no B symptoms
• Stage 1B – B symptoms
• Stage 1E – cancer is found in 1 organ or site outside the lymphatic system

Stage 2 HL is considered early (or limited) stage. Cancer is in 2 or more lymphatic sites that are either all above or all below the diaphragm.

• Stage 2A – no B symptoms
• Stage 2B – B symptoms
• Stage 2E – cancer is found in sites outside the lymphatic system

Stage 2 bulky disease means there is a tumour, or mass, that is larger than 10 cm or that takes up more than one-third of the mediastinum. At some treatment centres, people diagnosed with stage 2 HL with B symptoms or bulky disease are considered to have advanced HL for treatment planning purposes.

Stage 3 HL is considered advanced disease. Cancer is in lymphatic sites both above and below the diaphragm.

• Stage 3A – no B symptoms
• Stage 3B – B symptoms
• Stage 3E – cancer is found in sites outside the lymphatic system

Stage 4 HL is considered advanced disease. Cancer is in several lymphatic sites and has spread to other organs, such as the liver or bone marrow.

Relapsed (or recurrent) HL means that the lymphoma responded to treatment, but it has come back. It may recur in the same place it started or in a different part of the body.

Refractory HL means that the lymphoma didn’t respond to treatment or kept growing during treatment. Refractory HL is also called progressive disease.