Either of these conditions applies:
- The cancer is found in one lymph node region (e.g., neck or underarm) (Stage I).
- The cancer has invaded one extra lymphatic organ or site (denoted by “E”) but not spread to any lymph node regions (Stage IE).
Staging Non-Hodgkin Lymphoma
Staging is a careful process that determines whether the cancer cells have moved to other areas of the body and, if so, how extensively. The stage of the disease provides oncologists with insights into its seriousness, which helps them plan the most effective treatments for non-Hodgkin lymphoma.
Tests to Determine the Stage of Non-Hodgkin Lymphoma
Staging non-Hodgkin lymphoma may involve one or more of the following tests:
- Biopsy of enlarged lymph nodes: A sample of the lymph node can be examined under a microscope by a pathologist, who will determine if the cells are differentiated from those of a normal, healthy lymph node.
- Bone marrow aspiration and biopsy: This procedure uses a thick needle to remove a small sample of bone marrow from the hip bone or another large bone, often with the use of local anesthesia to minimize pain. A pathologist examines the sample for lymphoma cells under a microscope.
- CT scan: This X-ray technique captures a series of detailed images of the head, neck, chest, abdomen, or pelvis. A contrast material may be injected to help highlight swollen lymph nodes and other abnormal areas on the scan. Patients may also drink a different type of contrast material.
- Spinal tap: Also known as a lumbar puncture, this procedure involves inserting a long, thin needle into the spinal column to remove fluid. Local anesthesia can help relieve pain. Patients must lie flat for a few hours afterward to avoid headaches. The lab analyzes the fluid for the presence of lymphoma cells in the cerebrospinal fluid (CSF) that surrounds the brain and spine.
- PET scan: This test requires an injection of a small amount of radioactive sugar. A machine produces computerized images of how the sugar is used by cells in the body. Lymphoma cells consume sugar faster than normal cells, causing areas with lymphoma to appear brighter in the images.
- Bone scan: If there is reported pain in the bones or other indications of bone metastasis, the doctor will suggest a bone scan. A radioactive substance called technetium is injected into a vein and travels to areas of damaged bone, where a special camera detects the radioactivity.
Because lymphoma typically begins in the lymph nodes, the cancer cells can easily spread to various parts of the body, commonly affecting the liver, lungs, bone, and bone marrow.
Stages of Non-Hodgkin Lymphoma
The current staging system for non-Hodgkin lymphoma (NHL) in adults is known as the Lugano classification, which replaced the older Ann Arbor system. Non-Hodgkin lymphoma is classified into stages I, II, III, or IV, depending on the extent of tumor spread. Limited-stage (I or II) lymphomas that affect an organ outside the lymphatic system (referred to as an extranodal organ) have an E added (e.g., stage IIE).
Unlike other cancers, stage IV lymphomas do not indicate how well or poorly the patient will respond to treatment. Rather, it reflects the specific location of the disease. Even though stage IV NHL is the most advanced, treatment can still be successful.
Stage I Non-Hodgkin’s Lymphoma
Stage II Non-Hodgkin’s Lymphoma
Either of these conditions applies:
- The cancer is present in two or more lymph node regions on the same side of the diaphragm. (Stage II).
- The cancer involves one 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 Non-Hodgkin’s Lymphoma
Either of these conditions applies:
- The lymphoma is found in the lymph node areas on both sides of the diaphragm.
- The lymphoma is present in lymph nodes above the diaphragm and in the spleen.
Stage IV Non-Hodgkin's Lymphoma
The lymphoma has spread to at least one organ outside the lymphatic system, such as the bone marrow, liver, or lung.
Bulky Disease
This term is often used to describe large tumors in the chest and is especially significant for stage II lymphomas, as bulky disease might require more intensive treatment.
Recurrent Non-Hodgkin’s Lymphoma
Cancer that returns after treatment is called recurrent cancer. It may reappear in the original location or elsewhere in the body. Sometimes, recurrent lymphoma needs to be re-staged using the same system outlined above to determine the best treatment course.
Lymphoma Prognosis Factors in Staging
The staging process for non-Hodgkin Lymphoma (NHL) also includes an evaluation of the patient’s prognosis (outcome). The Eastern Cooperative Oncology Group (ECOG) Performance Status is a common scale used to assess a patient's ability to perform daily activities. After the evaluation, the results are graded based on a functional assessment scale.
The (ECOG) Performance Status grades are as follows:
- 0: Fully active, able to carry on all pre-disease activities without restriction
- 1: Restricted in physically strenuous activity but ambulatory; capable of light or sedentary work, such as light housework or office work.
- 2: Ambulatory and capable of all self-care but unable to engage in work activities; up and about for more than 50% of waking hours.
- 3: Limited self-care; confined to a bed or chair for more than 50% of waking hours.
- 4: Completely disabled; unable to perform any self-care and confined to a bed or chair.
- 5: Dead.
A lower score indicates a better prognosis. Generally, the more independent a person is in walking and performing self-care tasks, the better their prognosis.
Lymphoma Treatments Based on NHL Subtype, Staging, and Overall Health
Your oncologist will recommend a treatment plan tailored to be most effective based on your NHL stage and overall prognosis. Learn about the treatment options available for non-Hodgkin lymphoma.
Find a Non-Hodgkin Lymphoma Specialist in the Syracuse Area
At Hematology-Oncology Associates of CNY, we are committed to providing expert, patient-centered care for non-Hodgkin lymphoma. Our team of specialists ensures that each patient receives a personalized treatment plan based on the latest advancements in non-Hodgkin lymphoma.
Our cancer centers provide care for patients in Central New York, in the Syracuse area, including Camillus and all of Onondaga County; Auburn and the rest of Cayuga County; Oneida County, including Utica and Verona; Madison County, including Oneida; Jefferson County, including Watertown; and throughout Oswego County, including Fulton and Oswego.
Source: American Cancer Society, National Cancer Institute.
