Non-Hodgkin’s Lymphoma Stages

Staging is a process of finding out how far a cancer has spread. Once non-Hodgkin’s lymphoma is diagnosed, tests are done to determine the stage of the disease (extent of spread). The treatment and prognosis (outlook) for a patient with non-Hodgkin’s lymphoma depend on the exact type and the stage of the lymphoma.

Tests used to gather information for staging often include:

• physical examination
• blood tests
• bone marrow aspiration and biopsy
• a lumbar puncture (spinal tap) (this is not always done)
• imaging tests, including a chest x-ray, chest/abdomen/pelvis CT or MRI scan, and PET scan and/or gallium scan.

The staging system most often used to describe the spread of non-Hodgkin’s lymphoma in adults is called the Ann Arbor staging system. The stages are represented by Roman numerals I through IV. The letter “B” is added (stage IIIB, for example) if B symptoms (unexplained weight loss, soaking sweats, high fever,) are present. For patients without these symptoms, the letter “A” is added to their stage. Lymphomas that grow into organs from lymph nodes have “E” added to their stage (for example, stage IIE).

Stage I: The lymphoma is in a lymph node or nodes in only one region, such as the neck, groin, or underarm.

Stage II: The lymphoma is in two groups of lymph nodes, and these are on the same side of the diaphragm (the breathing muscle that aids breathing and separates the chest and abdomen). For example, this might include nodes in the underarm and neck area, but not the combination of underarm and groin nodes.

Stage III: The lymphoma is only in lymph nodes but on both sides of the diaphragm.

Stage IV: The lymphoma is widespread in an organ or organs, skin, or bone marrow.

International Prognostic Index

This index was developed to help predict the outcome of people with large cell lymphoma. The index depends on 5 factors. In the list below, the unfavorable prognostic factor is in bold type.

• age (below or above 60)
• stage (I and II vs. III and IV)
• absence or presence of lymphoma outside of lymph nodes
• performance status (able to function normally or needing lots of help with daily activities)
• serum LDH (a protein found in the blood that goes up in the presence of fast-growing tumors — the index looks for whether the LDH is normal or elevated)

For each unfavorable prognostic factor, 1 point is assigned. The index divides people with lymphomas into 4 categories. The low category (0 or 1 point) means that the person with lymphoma has mostly good factors (is young, has stage I disease, is able to work, and so on). The highest category (4 or 5 points) means mostly or all unfavorable factors (high stage, high LDH, can’t get out of bed, and so on). No matter what the type of lymphoma, more than 75% of people in the lowest group will live longer than 5 years, whereas only 30% of people in the highest group live 5 years.

The prognostic index lets a doctor plan treatment better than he or she could from just the pathology report and staging information. This has become more important as new, more effective treatments — but sometimes with more side effects — have been developed. The index tells us whether these treatments are needed.

NON-HODGKIN’S LYMPHOMA WORK-UP

NON-HODGKIN’S LYMPHOMA TREATMENT

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

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