Lymphoma - Hodgkin: Stages

Approved by the Cancer.Net Editorial Board, 04/2019

ON THIS PAGE: You will learn about how doctors describe the extent of a cancer’s growth or spread. This is called the stage. You will also discover what prognostic factors help doctors predict how well treatment will work. Use the menu to see other pages.

Staging helps to describe where the Hodgkin lymphoma 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 tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

When staging Hodgkin lymphoma, doctors evaluate the following:

  • The number of cancerous lymph node areas.

  • Whether the cancerous lymph nodes are localized or generalized. Localized means they are located only in 1 area of the body. Generalized means they are in many areas of the body.

  • Whether the cancerous lymph nodes are on 1 or both sides of the diaphragm, the thin muscle under the lungs and heart that separates the chest from the abdomen.

  • Whether the disease has spread to the bone marrow, spleen, or extralymphatic organs (organs outside the lymphatic system; noted using an “E” below), such as the liver, lungs, or bone.

Lymphoma stage groupings

The stage of lymphoma describes the extent of the spread of the tumor, using the terms "stage I" to "stage IV" (1 through 4). As explained in Symptoms and Signs, each stage may also be further divided into “A” and “B” categories, based on whether or not the person is experiencing specific symptoms.

Stage I: The cancer is found in 1 lymph node region. Or, the cancer has invaded 1 extralymphatic organ or site (identified using the letter “E”) but not any lymph node regions (stage IE); this is rare in Hodgkin lymphoma.

Stage II: Any of the following conditions applies:

  • Stage II: The cancer is in 2 or more lymph node regions on the same side of the diaphragm.

  • Stage IIE: The cancer involves 1 organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without cancer in other lymph node regions on the same side of the diaphragm.

  • Stage II bulky: Either stage II or stage IIE applies, plus there is a mass in the chest. The mass is either larger than one-third the diameter of the chest or larger than 10 centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stage III: There is cancer in lymph node areas on both sides of the diaphragm, meaning above and below it.

Stage IV: The lymphoma has spread to 1 or more organs beyond the lymph nodes. Hodgkin lymphoma usually spreads to the liver, bone marrow, or lungs.

Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur at any time, including shortly after the first treatment or years later. If the lymphoma 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.

Prognostic factors

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how well this treatment will work. For people with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. The lymphoma may be described as "high-risk disease" or "low-risk disease" based on how many of the following prognostic factors there are.

Factors that are considered less favorable and lead to a poorer prognosis include:

  • Being male.

  • Age 45 and older.

  • Low blood albumin (a type of protein) levels, defined as less than 4 g/L.

  • Low hemoglobin (red blood cell count), defined as less than 10.5 g/dL.

  • White blood cell count that is more than 15,000 per cubic millimeter (mm3).

  • Lymphocyte count that is less than 600 per mm3, less than 8% of the total white blood cell count, or both.

  • Stage IV disease.

Other prognostic factors that are considered, especially for early-stage Hodgkin lymphoma, include:

  • A higher erythrocyte sedimentation rate, or ESR (see "Laboratory tests" in Diagnosis), is associated with a poorer prognosis.

  • People with lymphocyte-predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte-rich classic Hodgkin lymphoma have a better prognosis, compared with other types of Hodgkin lymphoma.

  • A mediastinal lymph node mass, located in the center of the chest, that is larger than 10 cm is associated with a poorer prognosis. Small mediastinal masses are not associated with a poorer prognosis.

  • Having a high number of involved lymph node sites is associated with a poorer prognosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

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