Stages

If non-hodgkin 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.

Stages of Non-Hodgkin Lymphoma

Once Non-Hodgkin Lymphoma 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 Ann Arbor Staging System

Non-Hodgkin Lymphoma is staged by what is known as the Ann Arbor Staging 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 - Indicates that the lymphoma is in a lymph node or nodes in only 1 region, such as the neck, groin, or underarm. It also indicates the cancer is found only in 1 area of a single organ outside of the lymph system.

Stage II - Indicates the lymphoma is in 2 or more groups of lymph nodes on the same side of the muscle that separates the chest and abdomen (diaphragm.) It can also mean that the lymphoma has spread locally from a single group of lymph node(s) into a nearby organ or that other groups of lymph nodes on the same side of the diaphragm have been affected.

Stage III - Indicates that the lymphoma is found in lymph node areas on both sides of the diaphragm. It can also indicate that the disease may also have spread into an area or organ next to the lymph nodes, into the spleen or both.

Stage IV - Indicates that the lymphoma has spread outside of the lymph system into an organ that is not right next to an involved node. It can also indicate that the lymphoma has spread to the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs).

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

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

Letter "A" - Added if symptoms caused by Non-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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