Lymphoma - Hodgkin - Childhood: Stages and Groups

Approved by the Cancer.Net Editorial Board, 05/2021

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend what kind of treatment is best and can help predict a patient's prognosis, which is the chance of cure. There are different stage descriptions for different types of cancer. For childhood Hodgkin lymphoma, doctors use a staging system called the Ann Arbor system.

After the diagnostic tests (see the Diagnosis section) are completed, the doctor will assign a stage. This is needed to plan treatment. The 4 stages of Hodgkin lymphoma (I to IV; 1 to 4) are described below.

In addition, each person’s disease is put into 1 of 2 categories, “A” or “B,” based on whether the person has specific symptoms related to the disease. These symptoms include unexplained fever (at least 100.4 degrees Fahrenheit or 38 degrees Celsius for 3 consecutive days), drenching night sweats, or weight loss of 10% or more in the 6 months before diagnosis. “A” means the patient does not have these symptoms, while “B” means that the patient has at least 1 of these symptoms.

Another category is “E,” which means that the Hodgkin lymphoma has spread from the lymph node system to nearby tissues or organs.

Stage I: Cancer is in only 1 area of lymph nodes.

Stage IE: Cancer is in only 1 area or organ next to the lymph nodes, and there are no lymph nodes with cancer.

Stage II: Cancer is in 2 or more lymph node areas on the same side of the diaphragm.

Stage IIE: Cancer is in 1 lymph node area and in 1 area or organ next to the lymph nodes, with or without lymph nodes with cancer on the same side of the diaphragm.

Stage III: Cancer is in lymph node areas above and below the diaphragm. If the cancer has spread to the lymph nodes above the diaphragm, this stage indicates cancer is also in the spleen.

Stage IV: Cancer has spread outside of the lymph node system to the lungs, liver, bones, bone marrow, or other organs.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Risk grouping

Your child’s treatment plan may be selected based on the disease’s classification as low risk, intermediate risk, or high risk. This classification is based on several factors, including the cancer’s stage, whether the tumor is bulky, and whether the patient is experiencing specific symptoms. Those symptoms are defined as “A” or “B,” as explained above.

  • Low-risk Hodgkin lymphoma: The cancer is usually stage IA or stage IIA disease without bulky tumors or "E" lesions.

  • High-risk Hodgkin lymphoma: The cancer is in a later stage or is causing B symptoms like fever, drenching night sweats, or weight loss. This typically includes stages IIB, IIIB, and IVA or IVB.

  • Intermediate-risk Hodgkin lymphoma: Patients not in either low-risk or high-risk categories are usually considered to have intermediate-risk Hodgkin lymphoma.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.