‘Staging’ is the process of working out which parts of your body are affected by lymphoma (how ‘advanced’ your lymphoma is). The tests and scans you have when you are diagnosed help doctors to work out the stage of your lymphoma.
Staging lymphoma is important because it helps your medical team plan the most appropriate treatment for you. Different types and stages of lymphoma respond to different types and combinations of treatments.
- Staging for non-Hodgkin lymphoma in children is slightly different from staging in adults.
- Staging for chronic lymphocytic leukaemia (CLL), often considered a form of non-Hodgkin lymphoma, uses a different system. This is described on our webpage about CLL. Small lymphocytic lymphoma (SLL), which is a form of CLL affecting the lymph nodes, is staged the same as other non-Hodgkin lymphomas.
- Cutaneous (skin) lymphomas (lymphomas that start in the skin) behave differently from other lymphomas and are staged differently. Staging of skin lymphomas depends on whether they are B-cell skin lymphomas or T-cell skin lymphomas.
- Waldenström’s macroglobulinaemia, a rare type of non-Hodgkin lymphoma that does not often affect the lymph nodes, does not have a standard staging system.
Staging in adults is the same for Hodgkin lymphoma and non-Hodgkin lymphoma. There are four main stages of lymphoma. These are numbered 1 to 4, sometimes written in Roman numerals as I to IV. Letters after the numbers are sometimes also used.
Stage 1 means that there is lymphoma in only one group of lymph nodes (glands). The diagram shows these in the neck, but they can be anywhere in the body, either above or below the diaphragm (the sheet of muscle separating your chest from your tummy).
Stage 2 means there is lymphoma in two or more groups of lymph nodes. These can be anywhere in the body, but to be diagnosed with stage 2 lymphoma, they must all be on the same side of the diaphragm.
Stage 2E (extranodal lymphoma) means the lymphoma started in one body organ (not in the lymphatic system) and is also in one or more groups of lymph nodes. These must all be on the same side of the diaphragm.
Stage 3 means that there are lymph nodes that contain lymphoma on both sides of the diaphragm.
Stage 4 is the most advanced stage of lymphoma. Lymphoma started in the lymph nodes and has spread to at least one body organ outside the lymphatic system (for example, the lungs, liver, bone marrow or solid bones).
You may have the letters ‘A’ or ‘B’ after your stage. ‘A’ means you don’t have any of the following symptoms:
- unintentional weight loss
- drenching night sweats
- fevers (temperatures above 38°C).
‘B’ means you have one or more of these symptoms. They are sometimes called ‘B symptoms’.
For example, if your lymphoma is stage 2A, you have lymphoma in two or more groups of lymph nodes on the same side of your diaphragm and you haven’t had any of the B symptoms. However if you have had at least one B symptom, then you have stage 2B lymphoma.
Doctors also sometimes use the letter ‘E’, which stands for ‘extranodal’. It means that the lymphoma started in a body organ that is not part of the lymphatic system, for example, in the digestive system or in the salivary glands. It doesn’t include lymphoma that has started in a lymph node and spread to a body organ, which would be stage 4.
Lymphoma in the spleen and thymus
The spleen and the thymus are body organs that are part of the lymphatic system. Lymphoma that is in these organs is not regarded as extranodal. If you have lymphoma in the spleen, your doctor may put ‘S’ after your stage. For example, 1S is stage 1 lymphoma that is only in the spleen.
You might see the letter ‘X’ after your number. This means that one or more of your affected lymph nodes is large or ‘bulky’ (at least 10cm across).
Numbers after your stage
Occasionally, you may see a number in brackets or a smaller font next to your stage, for example stage 2(2) or 22. This second number tells you how many groups of lymph nodes contain lymphoma. For example, stage 2(2) means stage 2 lymphoma with lymphoma cells in two groups of lymph nodes.
Lymphoma in children and young people does not always behave the same way as lymphoma in adults. We cover staging of lymphoma in children and adolescents on this page. For further information, we have a separate section on lymphoma in children and young people.
Hodgkin lymphoma in children is staged the same way as in adults. Non-Hodgkin lymphoma is staged slightly differently.
There are four main stages of non-Hodgkin lymphoma in children and adolescents (under 20 years old). They are numbered 1 to 4, sometimes written in Roman numerals as I to IV. Letters after the numbers are sometimes also used.
Lymphoma in only:
- one group of lymph nodes, excluding the chest or abdomen (tummy) or
- one body organ outside the lymphatic system (extranodal lymphoma), excluding in the chest or abdomen (tummy) or
- one bone or
- the spleen.
- two or more lymph nodes on the same side of the diaphragm (the sheet of muscle separating your chest from your tummy) or
- one extranodal body organ and a nearby group of lymph nodes or
- the gut (nearby lymph nodes may also be affected as long as the lymphoma is localised and can be removed by surgery).
- two or more extranodal body organs (including bone or skin) or
- lymph nodes above and below the diaphragm or
- the chest or
- the gut (including the liver, spleen, kidneys or ovaries) unless it is localised and can be removed by surgery (see Stage 2) or
- around the spinal cord or
- one bone plus an extranodal body organ or distant lymph nodes.
- the central nervous system (brain or spinal cord) or
- the bone marrow.
There may be letters after the stage:
- ‘CNS’ shows that the lymphoma involves the central nervous system (brain or spinal cord).
- ‘BM’ shows that the lymphoma involves the bone marrow.
- ‘B’ show that the lymphoma affects bone.
- ‘EN’ shows that the lymphoma started outside the lymphatic system (extranodal).
- ‘N’ shows that the lymphoma affects the lymph nodes.
- ‘S’ shows that the lymphoma affects the skin.
You may hear your specialist talk about ‘early’ (or ‘limited’) stage or ‘advanced’ stage lymphoma. This is a simplified version of the staging described above.
‘Early’ stage means that you have either stage 1 or stage 2 lymphoma. ‘Advanced’ stage generally means that you have either stage 3 or stage 4 lymphoma.
The lymphatic system is all over the body, so it is common for lymphoma to be advanced stage when it is diagnosed. Unlike many other cancers, advanced stage lymphoma can be successfully treated. Depending on the exact type of lymphoma, it may be cured or kept under control for a long time.