‘Staging’ is the process of working out which parts of your body contain lymphoma. The tests and scans you have when you are diagnosed help the doctors to work out the stage.
Doctors group lymphomas into different stages because it helps them to plan treatment. They know from many years of research that particular stages respond best to particular amounts, types and combinations of treatments. Generally, staging is the same for most types of lymphoma. The same staging system is used for Hodgkin and non-Hodgkin lymphomas in adults.
There are a couple of exceptions:
- Cutaneous (skin) lymphomas start in the skin (rather than having spread there from somewhere else). They behave differently to other lymphomas and are staged differently, too.
- Staging for non-Hodgkin lymphoma in children is also slightly different to staging in adults.
Staging in adults is the same for Hodgkin and non-Hodgkin lymphoma. There are 4 main stages of lymphoma. These are numbered 1 to 4, sometimes written in Roman numerals as I to IV. Letters after the numbers can also appear.
Stage 1 means that there is lymphoma in only 1 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.
Stage 1E lymphoma means that the lymphoma started in a single body organ outside the lymphatic system and is only in that organ. This is called extranodal lymphoma.
Stage 2 means that there is lymphoma in 2 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.
In extranodal lymphoma, stage 2E means there is lymphoma that started in 1 body organ and is also in 1 or more groups of lymph nodes. These must all be on the same side of the diaphragm.
You may see a number in a smaller font next to the stage, for example stage 23. This ‘smaller’ number tells you how many groups of lymph nodes contain lymphoma. On the diagram, this is stage 2 lymphoma, with lymphoma cells in 3 groups of lymph nodes.
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 cells have spread to at least 1 body organ outside the lymphatic system, for example, the lungs, liver, bone marrow or solid bones.
The spleen and the thymus are part of the lymphatic system, so lymphoma in those organs only does not count as stage 4.
You may have ‘A’ or ‘B’ after your number stage. ‘A’ means you don’t have any of a set of general symptoms. ‘B’ means you have 1 or more of these general symptoms:
- unintentional weight loss (more than 10% in the 6 months before you were diagnosed)
- night sweats
- fevers (temperatures above 38°C).
Doctors sometimes call these ‘B symptoms’.
For example, if your stage is 2A, you have lymphoma in 2 or more groups of lymph nodes on the same side of your diaphragm and you haven’t had any of the B symptoms.
If your lymphoma is stage 1B, you have lymphoma in 1 group of lymph nodes and you have had at least 1 of the B symptoms.
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 spread to a body organ.
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; 1S is stage 1 lymphoma that is only in the spleen.
You may hear your doctor talk about ‘early’ 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. The lymph nodes that contain lymphoma cells are all on the same side of your diaphragm.
‘Advanced’ stage means that you have either stage 3 or stage 4 lymphoma. The lymph nodes containing lymphoma cells are on both sides of your diaphragm, or there is lymphoma that has spread to body organs outside your lymphatic system, such as your bone marrow, liver or lungs.
The lymphatic system is all over the body, so it isn’t unusual to find that lymphoma is widespread when it is diagnosed. Unlike many other cancers, stage 4 lymphoma can be successfully treated. Depending on the exact type of lymphoma, it may be cured or kept under control for a long time. It is important for doctors to stage your lymphoma accurately. Correctly identifying the stage of your lymphoma helps them to decide on the most suitable treatment, and gives them a baseline to monitor how well treatment is working.
You may hear your doctor talk about the ‘grade’ of your lymphoma. The grade describes what the lymphoma cells look like under a microscope.
The grade of your lymphoma also helps your doctor to decide which treatment is best for you.
Non-Hodgkin lymphoma is usually classed as either ‘high-grade’ or ‘low-grade’. High-grade lymphoma means that the cells look like they are dividing quite quickly. This means the lymphoma is likely to be relatively fast-growing.
Grading of follicular lymphoma
People with follicular lymphoma might also be given a numbered grade: 1, 2 or 3. This relates to the number of large, follicular lymphoma cells (centroblasts) that can be seen under a microscope:
- Grade 1 means that there are between 0 and 5 large cells.
- Grade 2 means that there are between 6 and 15 large cells.
- Grade 3 means that there are more than 15 large cells.
Grade 3 can be divided into 3A and 3B. In 3A, there are more than 15 centroblasts. In 3B, the tissue is almost entirely made up of these large lymphoma cells.
Grade makes no real difference to your treatment or likely outcome of follicular lymphoma, apart from 3B, which is regarded as faster growing than the other grades of follicular lymphoma. Grade 3B follicular lymphoma usually behaves and is treated like diffuse large B-cell lymphoma, which is a high-grade lymphoma.