Staging non-Hodgkin lymphoma
Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes if the non-Hodgkin lymphoma (NHL) is just in the lymph node area or organ where it started and whether or not the NHL is bulky. Your healthcare team uses the stage to plan treatment and estimate your prognosis.
Ann Arbor Staging System
The most common staging system for NHL is the Ann Arbor Staging System. Each stage is given a number from 1 to 4, usually as the Roman numerals I, II, III and IV. Generally, the higher the number, the more the cancer has spread. Doctors may also add the following letters to give more details about the stage.
E means that the NHL affects an organ or area of the body outside of the lymphatic system (called an extralymphatic site).
S means that the NHL affects the spleen.
A means that the person doesn’t have B symptoms.
B means the person has one or more B symptoms, which are:
- unexplained fever over 38°C that doesn’t go away
- drenching night sweats (enough to soak bedding and night clothes)
- unexplained weight loss of more than 10% of body weight within the last 6 months
X means that the NHL is bulky. Bulky disease includes:
- tumours in the chest that are at least one-third as wide as the chest
- tumours in other areas of the body that are 10 cm or more across
Cancer is in only one area of lymph nodes.
Cancer is in only one organ or area of the body outside of the lymphatic system. It isn’t in any lymph node area.
Cancer is in 2 or more lymph node areas on the same side of (either above or below) the diaphragm. The diaphragm is a thin muscle below the lungs that separates the chest from the abdomen.
Cancer is in one organ and nearby lymph nodes. It may also be in other lymph node areas on the same side of (either above or below) the diaphragm.
Cancer is in lymph node areas both above and below the diaphragm.
Cancer is in lymph node areas both above and below the diaphragm. It has also spread to an organ or area of the body near the affected lymph node areas.
Cancer is in lymph node areas both above and below the diaphragm and in the spleen.
Cancer is in lymph node areas both above and below the diaphragm. It has also spread to both the spleen and an organ or area of the body near the affected lymph node areas.
Cancer has spread outside the lymphatic system into an organ or area of the body that is not near an affected lymph node area.
The cancer has spread to the bone marrow, lungs, pleurapleuraThe thin layer of tissue that covers the lungs and lines the chest cavity. It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity., liver, brain or spinal cord.
Relapsed (recurrent) NHL means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local relapse. It may come back in another part of the body.
When NHL relapses, it usually comes back in the same form that it started in. This means that a low-grade (indolent) NHL usually relapses as a low-grade cancer. Sometimes a low-grade type of NHL relapses as a high-grade (aggressive) type of NHL.
Having refractory NHL means that your NHL has not responded to treatment.