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