Canadian Cancer Society logo

Hodgkin lymphoma

You are here: 

Stages of Hodgkin lymphoma

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for Hodgkin lymphoma (HL) is the Cotswold system, which is a modification of the older Ann Arbor system.

There are 4 stages of HL, with further classifications described by a letter:

  • "E" stands for extranodal and is added if the HL is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but nearby, the lymphatic tissues.
  • "S" is added if the HL involves the spleen.
  • Each stage may also be assigned the letter "A" or "B":
    • "A" is added when there are no symptoms.
    • "B" is added if one or more B symptoms are present:
      • unexplained fever over 38°C
      • unexplained weight loss – loss of more than 10% of body weight over the last 6 months
      • drenching night sweats
  • "X" may be added for bulky disease, which means the tumour is:
    • larger than one-third the width of the chest
    • at least 10 cm in its greatest dimension in areas other than the chest
  • Distant metastases are identified by a letter indicating the organ to which the HL has spread:
    • "N" for lymph nodes
    • "H" for liver
    • "L" for lung
    • "M" for bone marrow
    • "O" for bone
    • "D" for skin

Lymph nodes are grouped into areas or regions. The number of lymph node areas may be indicated with a subscript. For example, stage II HL with 3 areas of affected lymph nodes may appear as II3.

Stage grouping for Hodgkin lymphoma

The Cotswold staging system further groups the information into the stages listed in the table below.

Cotswold staging – Hodgkin lymphoma
Cotswold stageExplanation

stage I

HL is found in a single area of lymph nodes or single lymphatic structure such as the spleen or thymus.

stage IE

HL is found outside the lymph nodes in one organ or area.

stage II

HL is found in 2 or more lymph node areas on the same side of the diaphragmdiaphragmThe thin muscle below the lungs and heart that separates the chest cavity from the abdomen. (either above or below, but not both).

stage IIE

HL is found in one or more lymph node areas on the same side of the diaphragm (either above or below, but not both) and outside the lymph nodes in a nearby organ or area.

stage III

HL is found in lymph node areas both above and below the diaphragm.

stage IIIE

HL is found in lymph node areas on both sides of the diaphragm and in a nearby tissue or organ.

stage IIIS

HL is found in lymph node areas on both sides of the diaphragm and in the spleen.

stage IIIE+S

HL is found in lymph node areas on both sides of the diaphragm as well as in a nearby tissue or organ and in the spleen.

Stage III may be subdivided into stage III (1) and stage III (2)

stage III (1)

HL is found only in the upper abdomen, above the renal vein (vein that drains the kidney).

stage III (2)

HL is found in lymph nodes in the pelvis and/or near the heart.

stage IV

HL has spread to more than one organ outside the lymphatic system, and cancer cells may or may not be found in lymph nodes near these organs.

or

HL is found in only one organ outside the lymphatic system and in distant lymph nodes (lymph nodes far away from the organ).

Relapsed Hodgkin lymphoma

Relapsed HL means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic HL).

Refractory Hodgkin lymphoma

Refractory HL means that the cancer did not go away with treatment.

Stories

Dr John Dick Solving the mysteries of cancer stem cells

Read more

Clinical trial discovery improves quality of life

Illustration of test tubes

A clinical trial led by the Society’s NCIC Clinical Trials group found that men with prostate cancer who are treated with intermittent courses of hormone therapy live as long as those receiving continuous therapy.

Learn more