If lymphoma is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue.
Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if lymphoma spreads to the bones, the cancer cells in the bones are actually lymphoma cancer cells. The disease is metastatic lymphoma cancer, not bone cancer.

Stages of Lymphoma

Once Hodgkin is diagnosed, tests will be done to determine the stage or the spread of the disease. Treatment and prognosis (outlook) depends on both they type and stage of the disease.

The Cotswold Staging System
Hodgkin Disease/Lymphoma is staged by what is known as the Cotswold System. This system has 4 stages, which are labeled with the Roman numerals I, II, III, and IV. The higher the number, the more advanced the disease.

Stage I: Hodgkin Disease is found in only 1 lymph node area or lymphoid organ. It also indicates that the disease is found only in 1 area of a single organ outside the lymph system.

Stage II: Hodgkin Disease is found in 2 or more lymph node areas on the same side of the muscle beneath the lungs that separates the chest and abdomen (diaphragm.) Or, the cancer has extended locally from the lymph node(s) into a nearby organ.

Stage III: Hodgkin Disease is found in lymph node areas on both sides of the diaphragm or Hodgkin is resident in lymph nodes above and below the diaphragm, and has also spread to nearby organs, to the spleen or to both.

Stage IV: Hodgkin Disease has spread widely through 1 or more organs outside of the lymph system, such as liver, bone marrow, or lung.

In addition, letters can be assigned to the stages.

Letter "E" - Added to the stage and indicates that Hodgkin has affected an organ outside of the lymph system but is resident next to an affected lymph node

Letter "S" - Added to the stage indicates that Hodgkin is affecting the spleen

Letter "X" - Added to the stage to indicate diameter of tumors that are at least 4 inches across (this may need more intense treatment)

Each stage may also be assigned an "A" or a "B" indicator.

Letter "A" - Added if symptoms caused by Hodgkin are not present

Letter "B" - Added if the following symptoms are present:

A loss of more than 10% of body weight over 6 months 
A fever of 101.5°F or greater without any known cause 
Drenching night sweats

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