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Staging non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about the stages of non Hodgkin lymphoma. You can find the following information

 

A quick guide to what's on this page

Staging non Hodgkin lymphoma

Staging is important because your doctor uses the stage to work out the treatment you will need. The stage refers to the number of lymph nodes containing lymphoma cells and their position in the body. There are 4 stages of non Hodgkin lymphoma. Below is a simplified version of the staging system.

  • Stage 1 – you have lymphoma in one group of lymph nodes or in just one organ or area of the body
  • Stage 2 – you have lymphoma in 2 or more groups of lymph nodes. They are on the same side of your diaphragm
  • Stage 3 – you have lymph nodes affected on both sides of the diaphragm
  • Stage 4 – your lymphoma has spread outside the lymph nodes, for example, to the liver, bone marrow or lungs

Your doctor will write the letter E after the stage, if your lymphoma started in an organ or area of the body outside the lymphatic system. The E stands for extranodal lymphoma. Your doctor or nurse can explain to you about staging for extranodal disease.

The letter B will be put after your stage if you have night sweats, a high temperature that comes and goes, or have lost a lot of weight over a short period of time and don't know why. The letter A will be put after the stage if you do not have any of these symptoms. Your doctor needs to know about your symptoms because the treatment is sometimes different for people with B symptoms.

Stages of NHL made simple

To work out what treatment you need doctors also classify NHL as either 

  • Limited, which means stage 1 or 2, type A, and with all tumours less than 10 cm across
  • Advanced, which means stage 3 or 4, or type B, or any tumour more than 10 cm across

CR PDF Icon You can view and print the quick guides for all the pages in the Treating NHL section.

 

 

What staging is

The stage of the cancer means whether it is localised or has spread. The tests and scans you have to diagnose your lymphoma will give some information about the stage. Your doctor uses the stage to work out the treatment you will need. 

We have general information about the stages of cancer.

 

How NHL is staged

There are 4 stages of non Hodgkin lymphoma. Below is a simplified version of the staging system.

  • Stage 1 – you have lymphoma in one group of lymph nodes or in just one organ or area of the body
  • Stage 2 – you have lymphoma in 2 or more groups of lymph nodes. They are on the same side of your diaphragm
  • Stage 3 – you have lymph nodes affected on both sides of the diaphragm
  • Stage 4 – your lymphoma has spread outside the lymph nodes, for example, to the liver, bone marrow or lungs

The diaphragm (pronounced dia-fram) is a sheet of muscle just under the rib cage. The diagram shows you where it is.

Diagram showing the position of the diaphragm and the lymph nodes NHL may develop in

Doctors use the diaphragm as a guide for working out the stages of non Hodgkin lymphoma because it is about half way down the body.

At diagnosis, 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. In this case, your doctor will write the letter E after the stage number. Your doctor or nurse can explain more about the staging for extranodal lymphoma.

If you have lymphoma in your spleen, your doctor will write the letter S after the stage.

 

How symptoms are part of staging

As well as using your test results to work out the stage of your non Hodgkin lymphoma, your doctor will ask you about your symptoms. If you have any of the following symptoms your doctor will put the letter B after your stage:

  • 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

If you do not have any of these symptoms, the letter A will be put after the stage. 

For example, you have Stage 2B non Hodgkin lymphoma if you have

  • 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.

 

Stages of NHL made simple

To work out what types of treatment you need, doctors put people with non Hodgkin lymphoma into 2 groups. They call these groups limited disease and advanced disease.

Limited Disease

Limited stage disease means you have non Hodgkin lymphoma only on one side of your diaphragm and

  • Small tumours
  • No B symptoms (night sweats, temperatures or weight loss)

Advanced Disease

Advanced stage disease means you have non Hodgkin lymphoma on both sides of your diaphragm

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

More about NHL

If you would like more information about staging non Hodgkin lymphoma, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our non Hodgkin lymphoma organisations page gives details of other people who can provide information about NHL and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you. 

There are also books, booklets, CDs and other resources available about non Hodgkin lymphoma. Some of these are free. Look at our NHL reading list for details.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 1 September 2014