Canadian Cancer Society logo

Non-Hodgkin lymphoma

You are here: 

Stages of non-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 non-Hodgkin lymphoma (NHL) is the Ann Arbor Staging System. This system divides NHL into 4 stages that describe how much the disease has spread. Each stage may be further divided if the disease has spread to an organ or tissue other than the lymph nodes. This is called extranodal spread and is shown by adding an “E” to the stage number. Some doctors may also add the letter “S” to the stage number if the spleen is involved.

Ann Arbor staging – NHL
Ann Arbor stageExplanation

stage I

Cancer is found in a single area of lymph nodes.

stage I E

Cancer is found in a single organ or tissue other than the lymph nodes.

stage II

Cancer is found in 2 or more lymph node areas on the same side of the diaphragm* (either above or below, but not both).

stage II E

Cancer is found in 1 or more lymph node areas on the same side of the diaphragm (either above or below) and has spread to a nearby organ or tissue.

stage III

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

stage III E

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

stage III S

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

stage III S + E

Cancer is found in lymph node areas on both sides of the diaphragm, as well as in the spleen and in tissue and an organ nearby.

stage IV

Any spread to the liver, bone marrow, lung, pleura or brain is always considered stage IV.

OR

Cancer has spread to more than 1 organ outside of the lymphatic system and cancer cells may or may not be found in lymph nodes near these organs.

OR

Cancer is found in only 1 organ outside of the lymphatic system, and it has spread to distant lymph nodes.

* The diaphragm is a thin muscle below the lungs that separates the chest from the abdomen.

A and B classification

The letters A or B are also added to the stage number to indicate if the person with NHL has or not has specific symptoms, such as fevers, night sweats or unexplained weight loss (often referred to as B symptoms).

  • A shows the person does not have these symptoms.
  • B shows the person has these symptoms.

Tumour bulk

Non-Hodgkin lymphoma tumours may also be classified as being bulky or non-bulky, which describes the size of the tumour in the lymph nodes or organ.

  • Non-bulky means that all the tumours are less than 10 cm (4 inches).
  • Bulky disease means that the largest tumour is 10 cm or larger.

Limited and advanced staging

When planning treatment, doctors may put people with NHL into 1 of 2 groups based on the stage of their lymphoma, whether or not they have B symptoms and the size of their tumours (tumour bulk).

  • limited stage
    • stage I or stage II – cancer is found in a single lymph node area, a single organ or tissue other than the lymph nodes, or it is found in 2 or more lymph node areas but only on 1 side of the diaphragm
    • no B symptoms or “A” classification – no fever, night sweats or weight loss
    • non-bulky tumour – tumours are smaller than 10 cm
  • advanced stage
    • stage III or stage IV – cancer is found on both sides of the diaphragm, or it has spread to organs outside of the lymphatic system
    • B symptoms or “B” classification – fevers, night sweats or weight loss
    • bulky disease – tumours are 10 cm or larger

Recurrent NHL

Recurrent NHL 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. A slow-growing (indolent) lymphoma may recur either as an indolent lymphoma (most commonly) or as an aggressive lymphoma.

Stories

Researcher Dr Sohrab Shah Dr Sohrab Shah helped discover more than 100 new suspected cancer genes.

Learn more

Cancer information in over a hundred languages

Illustration of question mark

The Canadian Cancer Society’s Cancer Information Service (CIS) is Canada’s only national, bilingual, toll-free service that offers personalized comprehensive cancer information in over 100 languages.

Learn more