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Stages

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

The tests and scans you have to diagnose NHL will give the doctor information about your stage. The doctor will also ask you about your symptoms.

The doctor uses your stage to work out what treatment you need. 

The stages of non Hodgkin lymphoma

There are 4 main stages of non Hodgkin lymphoma, numbered 1 to 4

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

    Diagram showing the position of the diaphragm and the lymph nodes non Hodgkin lymphoma can develop in

    Extranodal (E)

    About a quarter of people with NHL have lymphoma that started in an organ or area of the body outside the lymphatic system. This is called extranodal lymphoma. Your doctor uses the letter E after the stage number if you have extranodal lymphoma. Your doctor or nurse can explain more about this.

    Spleen (S)

    Your doctor uses the letter S after the stage if you have lymphoma in your spleen.

    The staging system for NHL is complicated. Below is a simplified version.

    Stage 1 

    Stage 1 means one of the following:

    • you have lymphoma in one group of lymph nodes
    • you have lymphoma in just one organ or area of the body outside the lymphatic system (extranodal lymphoma)

    Stage 2

    Stage 2 means one of the following:

    • you have lymphoma in 2 or more groups of lymph nodes on the same side of your diaphragm
    • you have lymphoma in 1 or more groups of lymph nodes and also one nearby organ or area of body, all on the same side of the diaphragm

    Stage 3

    Stage 3 means one of the following:

    • you have lymphoma in lymph nodes on both sides of the diaphragm
    • you have lymphoma in lymph nodes on both sides of the diaphragm, and a nearby organ or area of your body is also affected

    Stage 4

    Stage 4 means one of the following:

    • you have lymphoma throughout one or more organs that are not part of the lymphatic system
    • you have lymphoma in an organ that is not part of the lymphatic system, and also in organs or lymph nodes far away from that organ
    • you have lymphoma in your liver, bone marrow, cerebrospinal fluid or lung (unless it has spread to your lung from nearby lymph nodes)

    Symptoms

    Your doctor also asks you about your symptoms to stage your NHL.

    They put the letter B after your stage if you have any of these symptoms:

    • night sweats
    • a high temperature that comes and goes
    • you have lost a lot of weight in a short period of time for no reason

    Your doctor puts the letter A after the stage if you do not have any of these symptoms.

    For example, stage 2B NHL could mean you have both of the following:

    • 2 groups of lymph nodes affected on the same side of the diaphragm
    • temperatures and night sweats

    Doctors need to know about your symptoms because the treatment is sometimes different for people with B symptoms.

    These stages made simple

    To work out a treatment plan, doctors put people with NHL into 2 groups. These groups are called limited disease and advanced disease.

    Limited disease

    Limited disease means you have NHL only on one side of your diaphragm, and you have:

    • small tumours
    • no B symptoms (night sweats, temperatures or weight loss)

    Advanced disease

    Advanced disease means you have NHL on both sides of your diaphragm, or you have one of the following:

    • a tumour of more than 10cm
    • any of the B symptoms

    Treatment

    The stage of your cancer helps your doctor to decide which treatment you need. Your treatment also depends on:

    • the type of cancer (the type of cells the cancer started in)
    • the grade of cancer (how much the cells look like normal cells)
    • where the cancer is
    • other health conditions that you have
    • your age

    The main types of treatment for NHL are:

    • chemotherapy
    • radiotherapy
    • biological therapy

    Other treatments include:

    • surgery
    • stem cell transplant

    You may have just one type of treatment, or a combination of treatments. 

    Last reviewed: 
    01 Sep 2014
    • Cancer Staging Manual (7th edition)
      American Joint Committee on Cancer
      Springer, 2010

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