Stages

It is important to know the stage of a cancer in order to plan treatment.

Stages of Adult Hodgkin's Lymphoma

Stages of adult Hodgkin's lymphoma may include A, B, E, and S.

• A: The patient has no symptoms.
• B: The patient has symptoms such as fever, weight loss, or night sweats.
• E: "E" stands for extranodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas.
• S: "S" stands for spleen and means the cancer is found in the spleen.

The following stages are used for adult Hodgkin's lymphoma:

Stage I

Stage I is divided into stage I and stage IE.

• Stage I: Cancer is found in one lymph node group.
• Stage IE: Cancer is found in an area or organ other than the lymph nodes.

Stage II

Stage II is divided into stage II and stage IIE.

• Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
• Stage IIE: Cancer is found in an area or organ other than the lymph nodes and in lymph nodes near that area or organ, and may have spread to other lymph node groups on the same side of the diaphragm.

Stage III

Stage III is divided into stage III, stage IIIE, Stage IIIS, and stage IIIS+E.

• Stage III: Cancer is found in lymph node groups on both sides of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
• Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and in an area or organ other than the lymph nodes.
• Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.
• Stage IIIS+E: Cancer is found in lymph node groups on both sides of the diaphragm, in an area or organ other than the lymph nodes, and in the spleen.

Stage III is also divided into stage III(1) and stage III(2) as follows:

• Stage III(1): Cancer is found only in the upper abdomen above the renal vein.
• Stage III(2): Cancer is found in lymph nodes in the pelvis and/or near the aorta.

Stage IV

In stage IV, the cancer either:

• is found throughout one or more organs other than the lymph nodes and may be in lymph nodes near those organs; or
• is found in one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

Adult Hodgkin's lymphoma may be grouped for treatment as follows:

Early Favorable

Early favorable adult Hodgkin's lymphoma is stage I or stage II, without risk factors.

Early Unfavorable

Early unfavorable adult Hodgkin's lymphoma is stage I or stage II with 1 or more of the following risk factors:

• A tumor in the chest that is larger than 1/3 of the width of the chest or at least 10 centimeters. Cancer in an organ other than the lymph nodes.
• A high sedimentation rate (in a sample of blood, the red blood cells settle to the bottom of the test tube more quickly than normal).
• Three or more lymph nodes with cancer.
• Symptoms such as fever, weight loss, or night sweats.

Advanced Favorable

Advanced favorable adult Hodgkin's lymphoma is stage III or stage IV with 3 or fewer of the following risk factors:

• Having a low blood albumin (protein) level (below 4).
• Having a low hemoglobin level (below 10.5).
• Being male.
• Being aged 45 years or older.
• Having stage IV disease.
• Having a high white blood cell count (15,000 or higher).
• Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).

Advanced Unfavorable

Advanced unfavorable Hodgkin's lymphoma is stage III or stage IV with 4 or more of the following risk factors:

• Having a low blood albumin (protein) level (below 4).
• Having a low hemoglobin level (below 10.5).
• Being male.
• Being aged 45 years or older.
• Having stage IV disease.
• Having a high white blood cell count (15,000 or higher).
• Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).

Stages of Childhood Hodgkin's Lymphoma

The letters "E" and "S" may be used to describe the stages of childhood Hodgkin's lymphoma.

• E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.
• S: Cancer is found in the spleen.

The following stages are used for childhood Hodgkin's lymphoma:

Stage I

Stage I is divided into stage I and stage IE.

• Stage I: Cancer is found in one group of lymph nodes.
• Stage IE: Cancer is found in one group of lymph nodes and has spread to a nearby organ or tissue that is not part of the lymph system.

Stage II

Stage II is divided into stage II and stage IIE.

• Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm.
• Stage IIE: Cancer is found in two or more lymph node groups on the same side of the diaphragm and has spread from one of those lymph nodes to a nearby organ or tissue that is not part of the lymph system.

Stage III

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E.

• Stage III: Cancer is found in lymph node groups on both sides of the diaphragm.
• Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and has spread from one of these lymph nodes to a nearby organ or tissue that is not part of the lymph system.
• Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.
• Stage IIIE+S: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen, and has spread from one of these lymph node groups to a nearby organ or tissue that is not part of the lymph system.

Stage IV

In stage IV:

• cancer is found throughout one or more organs that are not part of the lymph system and may be in lymph nodes near those organs; or
• cancer is found throughout one organ that is not part of the lymph system and in lymph nodes far away from that organ.

Untreated, classical Hodgkin's lymphoma is divided into risk groups.

Untreated, classical childhood Hodgkin's lymphoma is divided into risk groups based on the bulk of the tumor (tumors that are 5 centimeters or larger are considered "bulky") and whether the patient has "b" symptoms (fever, weight loss, or night sweats). Treatment is based on the risk group.

Low-risk disease:

• Patients with stage I or stage II disease; and
• No bulky tumors or "b" symptoms.

Intermediate-risk disease:

• Patients with stage I or stage II disease, with bulky tumors, or with "b" symptoms; or
• Patients with stage III or stage IV disease without "b" symptoms.

High-risk disease:

• Patients with stage III or stage IV disease with "b" symptoms.

Reference:

National Cancer Institute, USA.