Staging childhood non-Hodgkin lymphoma
Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes all the places where cancer is found in the body. The child’s healthcare team uses the stage to plan treatment and estimate prognosis.
The most common staging system for childhood non-Hodgkin lymphoma (NHL) is the St Jude Children’s Research Hospital (Murphy) staging system. This system can be used for all types of childhood NHL, but it is more commonly used in lymphoblastic and anaplastic lymphomas.
Recently, doctors have started to use other systems to assign childhood NHL to a risk group based on certain features. These risk groups help doctors decide which treatments to offer for childhood NHL that starts in B cells. This includes Burkitt lymphoma, Burkitt-like lymphoma, diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma.
St Jude Children’s Research Hospital staging system descriptions
Cancer is found in one place, and it isn’t in the mediastinummediastinumThe space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes. or the abdomen. It may be outside of the lymph nodes in tissue or an organ (called an extranodal tumour) or it may be in a single area of lymph nodes, such as lymph nodes in the neck, groin or underarm.
One of the following applies:
- Cancer is in 2 or more groups of lymph nodes that are on the same side of (above or below) the diaphragmdiaphragmThe thin muscle below the lungs and heart that separates the chest cavity from the abdomen..
- There is 1 tumour that started in tissue or an organ outside of the lymph nodes (called an extranodal tumour). It has spread to nearby lymph nodes.
- There are 2 tumours outside of the lymph nodes. Both tumours are on the same side of the diaphragm.
- Cancer is in the stomach or intestine. It may or may not have spread to nearby lymph nodes. The cancer is completely removed with surgery.
One of the following applies:
- Cancer is in 2 or more groups of lymph nodes that are on different sides of (above and below) the diaphragm.
- There are 2 tumours outside of the lymph nodes. The tumours are on different sides of the diaphragm.
- Cancer is in the mediastinum.
- Cancer is in the abdomen and it cannot be completely removed with surgery.
- Cancer is in an area close to the spine.
Cancer is in the bone marrow, the brain or spinal cord (called the central nervous system, or CNS) or both. It may also be found in other parts of the body.
Risk groups were defined by the FAB/LMB and BFM clinical trial groups and clinical trial protocols. Offering treatments based on the risk group (called risk-adapted therapy) helps make sure that children are given the most effective therapy at diagnosis, which increases the chance of successfully treating the NHL without causing unnecessary side effects. The Children’s Oncology Group (COG) uses the FAB/LMB risk group stratification schema for B-cell NHL.
The tumour is stage I and is completely removed with surgery.
There is a stage II tumour in the abdomen that is completely removed with surgery.
There are multiple tumours outside of the abdomen.
The tumour is stage I or II, and it can’t be completely removed with surgery.
The tumour is stage III.
The cancer is stage IV, and it has spread to the bone marrow (less than 25% of the cells in the bone marrow are blasts, or lymphoma cells). It hasn’t spread to the central nervous system (CNS).
The cancer has spread to the bone, bone marrow (more than 25% of the cells in the bone marrow are blasts) or CNS.
Recurrent non-Hodgkin lymphoma
Recurrent, or relapsed, NHL means that the cancer has come back after it has been treated. If it comes back in the same place where the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called distant recurrence.
Resistant or refractory non-Hodgkin lymphoma
Resistant, or refractory, NHL means that the lymphoma continues to grow or spread during treatment.