Stages of Adult Hodgkin Lymphoma
After adult Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For adult Hodgkin lymphoma, CT scans of the neck, chest, abdomen, and pelvis are taken.
- PET-CT scan: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
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Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
For pregnant women with Hodgkin lymphoma, staging tests that protect the fetus from the harms of radiation are used. These include:
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of adult Hodgkin lymphoma may include A, B, E, and S.
Adult Hodgkin lymphoma may be described as follows:
- 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 lymphoma:
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| Stage I adult Hodgkin lymphoma. Cancer is found in one or more lymph nodes in one lymph node group. In stage IE (not shown), cancer is found outside the lymph nodes in one organ or area. |
Stage I is divided into stage I and stage IE.
- Stage I: Cancer is found in one or more lymph nodes in one lymph node group.
- Stage IE: Cancer is found outside the lymph nodes in one organ or area.
Stage II is divided into stage II and stage IIE.
Stage II: Cancer is found in two or more lymph node groups above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).Enlarge 
Stage II adult Hodgkin lymphoma. Cancer is found in two or more lymph node groups, and both are either above (a) or below (b) the diaphragm.
Stage IIE: Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area.Enlarge 
Stage IIE adult Hodgkin lymphoma. Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area (a).
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| Stage III adult Hodgkin lymphoma. Cancer is found in one or more lymph node groups above and below the diaphragm (a). In stage IIIE, cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area (b). In stage IIIS, cancer is found in lymph node groups above and below the diaphragm (a) and in the spleen (c). In stage IIIS plus E, cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area (b), and in the spleen (c). |
Stage III is divided into stage III, stage IIIE, Stage IIIS, and stage IIIE+S.
- Stage III: Cancer is found in one or more lymph node groups above and below 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 above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
- Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
- Stage IIIE+S: Cancer is found in lymph node groups above and below the diaphragm, in a nearby organ or area, 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.
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| Stage IV adult Hodgkin lymphoma. Cancer is found outside the lymph nodes throughout one or more organs (a); or outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ (b); or in the lung, liver, or bone marrow. |
- is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
- is found outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ; or
- is found in the lung, liver, or bone marrow.
Adult Hodgkin lymphoma may be grouped for treatment as follows:
Early favorable adult Hodgkin lymphoma is stage I or stage II, without risk factors.
Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one 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 adult Hodgkin lymphoma is stage III or stage IV with three or fewer of the following risk factors:
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- 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 Hodgkin lymphoma is stage III or stage IV with four or more of the following risk factors:
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- 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).
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