Non-Hodgkin Lymphoma Stages

After a non-Hodgkin lymphoma diagnosis, the hematologist-oncologist will review available information from a biopsy, images, and other tests to determine the stage of the cancer. This will be used to plan the best treatment path. Staging considers several factors that identify the overall extent of the cancer.

Tests Used for Staging Non-Hodgkin Lymphoma

Staging non-Hodgkin lymphoma (NHL) may involve one or more of the following tests:

• Lymph node biopsy. This is a common type of biopsy used to confirm lymphoma. A small incision is made to remove part or all of the enlarged lymph node so it can be examined for the presence of cancer cells. 
• Bone marrow biopsy. Because lymphocytes start growing in the bone marrow, it may be necessary to remove a small sample of bone marrow from your hip bone or another large bone with a large needle to see if the bone marrow appears to be affected.
• CT scan or MRI. These images are used to see anything abnormal in the soft tissue.
• Ultrasound. Ultrasound can also be used to get a view of tissue inside your body. A small hand-held device is held against your body, and the waves bounce off nearby tissues. Tumors may produce echoes different from those made by healthy tissues that can be seen on the computer images.
• Spinal tap. This may not be necessary, but in some cases, the oncologist will remove fluid from the spinal column to check for lymphoma cells or other problems. 
• PET scan. To make computerized pictures of the sugar being used by cells in your body, you receive an injection of a small amount of radioactive sugar. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter in the pictures.

Non-Hodgkin Lymphoma Stages

Staging is a way of describing how far the cancer spread (metastasized). The stage is based on where lymphoma cells are found in the lymph nodes or in other organs or tissues. It also depends on how many areas are affected. Doctors use the stage and other factors to determine what treatments will likely be the most effective for your cancer.

The Lugano classification, based on the older Ann Arbor system, is currently used for staging lymphoma. The stages of non-Hodgkin lymphoma describe the extent of the spread of the tumor using the Roman numerals I, II, III, or IV (1 through 4). Unlike other cancers, a stage IV lymphoma diagnosis does not reflect how well or poorly the patient will respond to treatment but rather the specific location of the disease. Even though stage IV lymphomas are the most advanced, they can still be treated successfully. 

Stage I Non-Hodgkin Lymphoma 

Either of these conditions applies:

• The lymphoma cells are in one lymph node group (such as in the neck or underarm) (stage I).
• The cancer has invaded 1 extra lymphatic organ or site (identified using the letter “E”) but not any lymph node regions (stage IE).

Stage II Non-Hodgkin Lymphoma 

Either of these conditions applies: 

• The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm (stage II).
• The cancer involves 1 organ and its regional lymph nodes, with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III-IV Non-Hodgkin Lymphoma 

The lymphoma is in lymph node areas on both sides of the diaphragm (stage III), or lymphoma cells have spread to several parts of one or more organs or tissues (in addition to the lymph nodes). It may be found in the liver, blood, or bone marrow. (stage IV). Stage III-IV lymphomas are common, still very treatable, and often curable, depending on the NHL subtype. Because stage III and stage IV have the same treatment and prognosis, they are now considered a single category. 

Progressive or Refractory Non-Hodgkin Lymphoma

Cancer that grows larger or spreads while the patient is being treated for the original lymphoma is referred to as progressive disease or refractory NHL.

Recurrent Non-Hodgkin Lymphoma

This describes cancer that comes back after treatment. It may return to the area where it first started or somewhere else in the body. Sometimes, recurrent lymphoma may need to be re-staged using the system above. 

The Patient’s Prognosis is Also Evaluated in the Staging Process

In addition to where the cancer is physically located throughout the patient’s body, the oncology team will also use some indicators as to the likely outcome of their treatments.

An assessment is performed to see how well the patient can carry out daily activities. This is evaluated on a functional assessment scale. A common scale that is used is the Eastern Cooperative Oncology Group (ECOG) Performance Status.

The (ECOG) Performance Status grades are as follows:

• 0: Fully active, able to carry on all pre-disease performance without restriction
• 1: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work.
• 2: Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours.
• 3: Capable of only limited self-care, confined to bed or chair for more than 50% of waking hours.
• 4: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair.
• 5: Dead

A lower score indicates a better functional status. Typically, the better someone is able to walk and care for themselves, the better the prognosis.

Lymphoma Treatments Are Based on the Specific Subtype of NHL, the Stage, and the Patient’s Overall Health Condition

Your hematologist-oncologist will recommend a set of treatments that are most likely to be effective based on your stage and overall prognosis. Learn more about lymphoma treatments.