Stages of non-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 systems for non-Hodgkin lymphoma (NHL) are the Ann Arbor and Lugano staging systems. The systems are similar, and Lugano is based on the Ann Arbor system. In both of these systems there are 4 stages. 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. Talk to your doctor if you have questions about staging.

Doctors stage NHL by looking at:

• the number of groups of lymph nodes that have lymphoma
• which lymph nodes have lymphoma and whether they are on 1 or both sides of the diaphragm
• whether the lymphoma is found in an organ or tissues other than lymph nodes
• whether the lymphoma has spread in the same area of the body or farther away

NHL can also be divided into categories, and the following letters may be added to the stage number:

A – You don’t have a fever, excessive sweating or weight loss.

B – You have an unexplained fever that doesn’t go away, drenching night sweats and unexplained weight loss.

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

S – The lymphoma has spread to the spleen.

X – There are large areas of lymphoma (called bulky disease).

Lymphoma is in 1 group of lymph nodes.

Stage 1E

Lymphoma is in only 1 area outside of the lymph nodes.

Lymphoma is in 2 or more groups of lymph nodes. The lymph nodes with lymphoma are either all above or all below the diaphragm.

Stage 2E

Lymphoma is in lymph nodes either all above or all below the diaphragm. The lymphoma has also spread into tissue near the lymph nodes.

Lymphoma is in lymph nodes both above and below the diaphragm.

Stage 3S

Lymphoma is in the spleen and lymph nodes above the diaphragm.

Lymphoma is widespread and found in multiple areas of the body such as the lungs, liver, bone, bone marrow or cerebrospinal fluid (CSF). Lymphoma is also usually in the lymph nodes.

Relapsed (recurrent) NHL means that the lymphoma has come back after it has been treated. If it comes back in the same place that the lymphoma first started, it’s called local relapse. But it may come back in another part of the body.

When NHL relapses, it usually comes back in the same form that it started in. This means that a low-grade (indolent) NHL usually relapses as a low-grade lymphoma. But sometimes a low-grade type of NHL relapses as a high-grade (aggressive) type of NHL.

Refractory NHL means that the lymphoma has not responded to treatment. Refractory NHL is also called progressive disease.