Keypoints

Principles of staging non-Hodgkin's lymphoma

Deciding the stage of a non-Hodgkin's lymphoma depends on where it is in the body, how many groups of lymph nodes are affected, and whether it has spread to other parts of the body. This involves a number of staging tests to find out the extent of the disease.

Although there are several systems used to stage non-Hodgkin's lymphoma, including the Ann Arbor system, the most common staging system uses four stages, numbered in Roman numerals I-IV. In its simplest form, stages I and II are often grouped together as early-stage disease, while stages III and IV are grouped together as advanced-stage disease.

• Stage I - the lymphoma is in only one group of lymph nodes
• Stage II - two or more groups of lymph nodes are affected, but are on one side of the diaphragm, either all in the chest or all in the abdomen
• Stage III - two or more groups of lymph nodes are affected, in both the chest and the abdomen
• Stage IV - lymphoma is in at least one organ other than the lymph nodes (for example, the bone marrow, the liver, or the lungs)

The most common staging system for non-Hodgkin's lymphoma uses four stages numbered in Roman numerals. Stages I and II are often called early-stage (left) and stages III and IV are termed late-stage (right) non-Hodgkin's lymphoma

In addition, the letter 'A' or 'B' is sometimes added to the stage number, depending on whether or not any of three specific symptoms is present:

• Recurrent, unexplained fevers (with body temperature over 38^oC)
• Night sweats
• Unintended weight loss of more than 10% of the body weight in 6 months

'A' means that none of these symptoms is present, while 'B' means that at least one has been seen. So, for example, a person with stage IIB non-Hodgkin's lymphoma has lymphoma in two or more groups of lymph nodes, all of which are either in the chest or in the abdomen, and has one or more of the three symptoms above. A person with stage IVA non-Hodgkin's lymphoma has lymphoma that has spread outside the lymph nodes and has none of these three symptoms.