Lymphoma staging
The stage of lymphoma you are diagnosed with is a description of how much of your body is affected. Knowing the stage of your lymphoma helps your doctor to plan the best treatment for you.
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What is staging?
‘Staging’ is the process of working out which parts of your body are affected by lymphoma. Tests and scans 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 treatments.
It is common for lymphoma to be at an advanced stage when it is diagnosed because the lymphatic system runs throughout your body. However, there is often effective treatment for advanced stage lymphomas.
Hearing it was stage 4 was a gut punch, as for most cancers this would be awful news. But lymphoma is different because the lymphatic system is all over the body, so we were told it is common for lymphoma to be stage 4 when diagnosed. We were told it was likely to be highly treatable, which took some of the worry out in a way.
Staging systems
The same staging system is used for most Hodgkin and non-Hodgkin lymphomas. This is called the ‘Lugano classification’ and is described below.
However, there are a few exceptions:
- 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 from other non-Hodgkin lymphomas. This is described on our information 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.
- Skin (cutaneous) 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 (WM), a rare type of non-Hodgkin lymphoma that does not often affect the lymph nodes, is staged differently to the standard staging system. WM is staged by giving a score between 0 and 5, which is based on age and blood test results.
Staging of lymphoma in adults
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.
Staging of lymphoma is based on where the lymphoma is in the body in relation to the diaphragm (the sheet of muscle separating your chest from your tummy, which is roughly halfway down your body).
Stage 1
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.
Stage 1E means that the lymphoma started in a single organ outside the lymphatic system (for example, the thyroid gland) and is only in that organ. This is called extranodal lymphoma.
Stage 2
Stage 2 means there is lymphoma in two or more groups of lymph nodes. These can be anywhere in the body but they must all be on the same side of the diaphragm (either above or below).
Stage 2E means that the lymphoma started in one body organ (not in the lymphatic system) and is also in one or more groups of lymph nodes (for example, the stomach and nearby nodes). These must all be on the same side of the diaphragm. This is called extranodal lymphoma.
Stage 3
Stage 3 means there are lymph nodes that contain lymphoma on both sides of the diaphragm.
Stage 4
Stage 4 means that lymphoma that started in the lymph nodes has spread to at least one 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 is not stage 4.
Your doctors might talk about ‘early’ stage or ‘advanced’ stage lymphoma.
- ‘Early’ stage means either stage 1 or stage 2 lymphoma.
- ‘Advanced’ stage generally means either stage 3 or stage 4 lymphoma.
When I was diagnosed I was told I was at stage 4 (advanced or ‘aggressive’) lymphoma. I asked ‘how many stages are there?’ and found it very worrying to hear the answer. However, my consultant explained that stage 4 lymphoma can be very responsive to treatment, and that really helped.
Letters
You might also have a letter following your stage number (not all hospitals do this).
- The letter ‘A’ means that you don’t have any of the following symptoms:
- unexplained significant weight loss (more than 10% of your usual body weight)
- drenching night sweats
- fevers (temperatures above 38°C).
- The letter ‘B’ means that you have one or more of these symptoms (often called ‘B symptoms’):
- unexplained significant weight loss (more than 10% of your usual body weight)
- drenching night sweats
- fevers (temperatures above 38°C).
- The letter ‘E’ 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.
- The letter ‘S’ means that you have lymphoma in your spleen. The spleen is part of the lymphatic system and so this is not regarded as extranodal.
- The letter ‘X’ means that one or more of your affected lymph nodes is considered to be large or ‘bulky’.
Staging of lymphoma in children
Hodgkin lymphoma in children is staged the same way as in adults. The stage is then often used to help determine a ‘Treatment Level’ which is a system used by doctors to help decide the right treatment for an individual.
Non-Hodgkin lymphoma is staged slightly differently. There are four main stages of non-Hodgkin lymphoma in children and young people under 20 years old. They are numbered 1 to 4, sometimes written in Roman numerals as I to IV. It is becoming more common for doctors to talk about ‘early stage’ or ‘advanced stage’ when describing lymphoma in children and young people.
Stage 1
Lymphoma in:
- 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.
Stage 2
Lymphoma in:
- 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 might also be affected) as long as the lymphoma is localised and can be removed by surgery.
Stage 3
Lymphoma in:
- 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.
Stage 4
Lymphoma in:
- the central nervous system (brain or spinal cord) or
- the bone marrow.
There might also be letters given after the stage number:
- ‘B’ means that the lymphoma affects bone.
- ‘BM’ means that the lymphoma involves the bone marrow.
- ‘CNS’ means that the lymphoma involves the central nervous system (brain or spinal cord).
- ‘EN’ means that the lymphoma started outside the lymphatic system (extranodal).
- ‘N’ means that the lymphoma affects the lymph nodes.
- ‘S’ means that the lymphoma affects the skin.
For further information, we have a separate section on our website about lymphoma in children and young people.