stage 3 lymphoma | Stages of Hodgkin's lymphoma

Stages of Hodgkin's lymphoma

After the diagnosis of Hodgkin's lymphoma, doctors will try to find out if it has spread and if so, how far. This process is called staging (or stage determination). The stage of a cancer describes how much cancer is in the body, and helps to determine how serious cancer is, as well as how best to treat it. Doctors also use the cancer stage when they talk about survival statistics.

Hodgkin's lymphoma is usually initiated in the lymph nodes. If it spreads, it usually does it to another set of adjacent lymph nodes. It can also invade (grow towards) adjacent organs. In few cases, Hodgkin's lymphoma will originate in an organ other than lymph nodes, such as a lung.

The stage is based on the following:

Your medical history
If you develop certain symptoms (called symptoms B)
Physical exam
Biopsies
Imaging studies that usually include chest X-ray, chest/abdomen/pelvis computed tomography, and positron emission tomography (PET)
Bone marrow aspiration and biopsy (sometimes done, but not always)
These tests, tests, and biopsies are discussed in tests for Hodgkin's lymphoma.

In general, the results of imaging studies, such as PET and CT, are the most important when determining the stage of lymphoma.

Lugano classification
A staging or stage grading system is a method used by cancer specialists to summarize the extent of the spread of a cancer. The staging system used for Hodgkin's lymphoma is known as the Lugano classification, and is based on the old Ann Arbor system. This system has four stages, identified with the Roman numerals I, II, III, and IV.

For the limited stage (I or II) of Hodgkin's lymphoma that affects an organ outside the lymphatic system, the letter "E" is added to the stage (e.g. IE or IIE stage).

Stage I: any of the following means that Hodgkin's lymphoma is in stage I:

Hodgkin's lymphoma is found only in a lymph node area or a lymphatic organ, such as the thymus (I).
Cancer is found only in a part of an organ that is outside the lymphatic system (IE).
Stage II: Any of the following means that Hodgkin's lymphoma is in stage II:

Hodgkin's lymphoma is found in two or more lymph node areas on the same side (upper or lower) of the diaphragm (the thin muscle under the lungs that separates the thorax and abdomen [II]).
The cancer is spread locally from a lymph node area to an adjacent organ (IIE).
Stage III: Any of the following means that Hodgkin's lymphoma is in stage III:

Hodgkin's lymphoma is found in areas of lymph nodes on both sides (upper and lower) of the diaphragm (III).
Hodgkin's lymphoma is found in the lymph nodes above the diaphragm, and in the spleen.
Stage IV: Hodgkin's lymphoma has spread widely to at least one organ outside the lymphatic system, such as the liver, bone marrow, or lungs.

Other modifiers may also be used to describe the stage of Hodgkin lymphoma:

Bulky disease
This term is used to describe tumors in the thorax that are at least the width of ⅓ of the thorax, or tumors in other areas that are at least 10 centimeters (about 4 inches) wide. It is usually designated in this way by adding the letter X to the stage. This is especially important for stage II lymphomas, as bulky disease may require more intensive treatment.

A vs. B
A letter (A or B) can also be assigned to each stage. The letter B (for example, stage IIIB) is added if the person presents any of these symptoms B:

Weight loss of more than 10% in the 6 months prior to diagnosis (without diet)
Unexplained fever of at least 100.4 ℉ (38 °c)
Profuse sweating during the night
If a person has any B symptoms, this usually means that the lymphoma is more advanced, and more intensive treatment is often recommended. If none of the symptoms B is present, the letter A is added to the stage.

Resistant or recurrent Hodgkin's lymphoma
Resistant or recurrent Hodgkin's lymphoma is not part of the formal staging system, but physicians or nurses may use these terms to describe what is happening with lymphoma in some cases.

The terms resistant or progressive disease are used when the lymphoma does not go away or progresses (grows) while you are under treatment.
Recurrent or relapsing disease means that Hodgkin's lymphoma disappeared with treatment, but is now returning. If the lymphoma returns, it may do so in the same place where it started or in another part of the body. This may occur shortly after treatment or years later.