Stages of non-Hodgkin lymphoma

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. The healthcare team uses information from tests to find out the size of the tumour and where the cancer has travelled in the body. Doctors use the stage to plan treatment and estimate the outcome (prognosis).

The most common staging systems for non-Hodgkin lymphoma (NHL) are the Ann Arbor and Lugano staging systems. Lugano is based on the Ann Arbor system. Both systems have 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.

When describing the stage, doctors may use the words limited and advanced.

Limited stage includes stage 1 and stage 2 with lymphoma in up to 3 lymph node regions that are beside one another.

Advanced stage includes:

• stage 2 with lymphoma in more than 3 lymph node regions that are not beside one another
• stage 3
• stage 4
• B symptoms (unexplained fever that doesn't go away, drenching night sweats and unexplained weight loss)
• bulky disease (an area of lymphoma that is bigger than 10 cm)

Your doctor may add certain letters to the stage number to describe other features of the lymphoma, such as if it is causing symptoms or if it is in specific places. For example, the letter E can be used to describe a stage 1 or 2 lymphoma that is also found in outside of the lymph nodes within nearby tissue.

Sometimes the healthcare team may need to stage NHL again (called re-staging). They may re-stage NHL to see how well it responded to treatment or if it came back after it was treated.

Talk to your doctor if you have questions. Find out more about staging cancer.

Lymphoma is only in one group of lymph nodes or one lymph organ.

If lymphoma is also outside the lymph nodes in only one area, it is called stage 1E.

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

If lymphoma is in one group of lymph nodes and one nearby organ, it is called stage 2E. The lymphoma may also be in other groups of lymph nodes that are either all above or all below the diaphragm.

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

Lymphoma is widespread. This means that it is found in different 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 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 area of the body.

When NHL relapses, it usually comes back in the same form that it started in. This means that an indolent (slow-growing) NHL usually relapses as an indolent lymphoma. But sometimes an indolent type of NHL relapses as an aggressive (fast-growing) type of NHL.

Refractory NHL means that the lymphoma has not responded to treatment or comes back soon after being treated.