This article specifically addresses Non-Hodgkin Lymphoma (NHL) types.
Lymphoma stages are part of a categorization system called “staging”, which is designed to identify the general features of a lymphoma.
Such features include where the cancer is geographically in the body and how far it has spread (if at all).
In conjunction with identifying lymphoma stages, a doctor is also going to determine the “grade” of a patient’s lymphoma.
Lymphoma grading determines how aggressive the lymphoma is, based upon how quickly it spreads and grows.
Together, grade and stage of a lymphoma are the most vital pieces of information that will determine the course of treatment that will be prescribed.
For the non-hodgkin types of lymphoma, grade is the most important metric in foreseeing the probable outcome with and without treatment.
Lymphomas are typically grouped into 1 of 3 different grades.
- Low Grade or so-called “indolent” lymphomas – These are lymphomas that grow very slowly if at all, and can be present in patient for several years without the need for treatment.
- Intermediate Grade or so-called “aggressive” lymphomas – These lymphomas grow relatively quickly.
- High Grade or “highly aggressive” lymphomas – These are extremely fast-growing lymphomas
Staging is another important aspect of predicting outcome and also prescribing a prudent course of treatment.
In simplistic terms, the stage describes how far the cancer has “metastasized”, or spread from the location of origin.
The more confined a lymphoma is to one location, the easier it typically is to treat it and the less invasive the treatment options usually are.
A tumor in one location can often be removed surgically or with radiation therapy, whereas a lymphoma that has spread to several areas of the body often calls for a systemic treatment (e.g. chemotherapy or a combination therapy such as chemo plus radiation).
Lymphomas are categorized into 4 stages, stages I, II, III and IV.
Stage I is the least serious and stage IV is the most serious.
The stages are described as follows:
- Stage I – The lymphoma is a single tumor that has not spread.
- Stage II – There are several tumors. However, the tumors are all located in lymph nodes on the same side of the diaphragm, either all above the diaphragm or all below it. Stage II can also indicate that the lymphoma has spread to an organ, but it is close to the site of the original tumor.
- Stage III – Several tumors found both above and below the diaphragm. Tumors may be located in the spleen or in nearby organs.
- Stage IV – Many tumors spread out within an organ like the liver, stomach, etc., in addition to being in the lymph nodes. Stage IV can also refer to tumors found in parts of the body distant from each other.
To determine staging, a doctor typically needs to know:
- How many lymph nodes are cancerous and which ones
- Which side of the diaphragm are the affected lymph nodes on (above, below, or both?)
- Has the disease spread outside of the lymphatic system (i.e. to the bone marrow, spleen, etc.)?
Staging will include any of several diagnostic tests such as:
- A biopsy of the bone marrow. This procedure requires insertion of a needle into the hip bone or other substantial bone to extract bone marrow.
- A CT scan or lymphangiogram.
- Taking and evaluating samples of tissue from various organs such as the stomach, liver, etc., to determine if cancer cells are present there.
- In the event that a CT scan cannot be done, a doctor can perform a laparotomy, which involves cutting open the stomach and taking samples of tissue. However, a CT scan has a higher accuracy and is less invasive.
- Samples of tissues in other various locations.