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The stage shows whether the lymphoma is in one area of your body (localised) or has spread to other areas.There are 4 stages for Hodgkin lymphoma.

Knowing the stage helps your doctor to decide what treatment you need.

Stage 1

This means there is Hodgkin lymphoma in either:

  • 1 group of lymph nodes
  • 1 body organ 
Diagram showing stage 1 Hogkin lymphoma

Treatment for stage 1 Hodgkin lymphoma is usually 2 to 4 cycles of chemotherapy. You might also have radiotherapy.

Stage 2

This means Hodgkin lymphoma is in either:

  • 2 or more groups of lymph nodes
  • an organ and 1 or more group of lymph nodes

In both cases, the 2 sites of lymphoma must be on the same side of the diaphragm.

The diaphragm (pronounced dia-fram) is a sheet of muscle just under the rib cage. Doctors use the diaphragm as a reference point for working out the stages of Hodgkin lymphoma because it is about halfway down the body.

Diagram showing stage 2 Hodgkin lymphoma

Treatment for stage 2 Hodgkin lymphoma, is usually 2 to 4 cycles of chemotherapy. You might also have radiotherapy.

Stage 3

This means the Hodgkin lymphoma is on both sides of the diaphragm. 

Diagram showing stage 3 Hodgkin lymphoma

Treatment for stage 3 Hodgkin lymphoma, is generally up to 8 cycles of chemotherapy. You might have steroids as part of this. And you may also have radiotherapy.

Stage 4

This means that many groups of lymph nodes contain Hodgkin lymphoma and it has spread to body organs such as the liver, bones or lungs.

Diagram showing stage 4 Hodgkin lymphoma

Treatment for stage 4 Hodgkin lymphoma,is usually up to 8 cycles of chemotherapy. You might have steroids as part of this. And you may also have radiotherapy.

B symptoms

Your doctor will add the letter B to your stage (for example, stage 1B) if you have any of the following symptoms:

  • heavy sweating at night
  • high temperatures that come and go, often at night
  • unexplained weight loss (more than a tenth (10%) of your body weight in the last 6 months)

If you don't have any of these symptoms your doctor will add the letter A to your stage (for example, stage 2A).

People with B symptoms may need more treatment than those without them.

Bulky disease

This means you have either:

  • a lymph node that is 10cm or more
  • lymphoma in the centre of your chest (mediastinum) which is at least a third of the width of your chest

If you have bulky disease, your doctor may add the letter X to your stage.

Lymphoma in your spleen

The letter S will be put after your stage if you have lymphoma in your spleen. The spleen is a large organ to the left of your stomach. It is part of the lymphatic system, and it helps to filter old or damaged blood cells and fight infection.

Lymphoma outside the lymphatic system

Your doctor may put the letter E after your stage. This stands for extranodal extension. It means the lymphoma has spread outside of the lymphatic system.

Early or advanced Hodgkin lymphoma

Your doctor may describe your lymphoma as being early stage or advanced. Usually early stage Hodgkin lymphoma means stage 1 or 2A with no bulky disease.

Advanced Hodgkin lymphoma usually means stage 2B, 3 or 4, or any stage with bulky disease.

Hodgkin lymphoma that comes back

Hodgkin lymphoma that has come back after it has been treated is called recurrent disease.

Your doctors will not stage it in the same way as when you were first diagnosed. But you can still have more treatment and this will often work well. Your treatment may include a stem cell transplant.

Last reviewed: 
18 Dec 2014
  • Guidelines for the first line management of classical Hodgkin lymphoma
    GA Follows, KM Ardeshna, SF Barrington and others
    British Journal of Haematology, 2014, Volume 166

  • Cancer Staging Manual (7th edition)
    American Joint Committee on Cancer
    Springer, 2010

  • Essential Haematology (5th edition)
    V Hoffbrand, P Moss, J Pettit
    Wiley, 2006

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