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The stages of Hodgkin lymphoma

Men and women discussing Hodgkin's lymphoma

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

 

A quick guide to what's on this page

The stages of Hodgkin lymphoma

The stage of the Hodgkin lymphoma means whether it is localised or is in more than one area of the body. Your doctor uses the stage to work out the treatment you will need.

  • Stage 1 means there is Hodgkin lymphoma in only 1 group of lymph nodes or lymphoma in 1 body organ only
  • Stage 2 means Hodgkin lymphoma in 2 or more groups of lymph nodes or 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
  • Stage 3 means Hodgkin lymphoma in lymph nodes on both sides of the diaphragm
  • Stage 4 means that many groups of lymph nodes contain Hodgkin lymphoma and it has spread to body organs such as the liver, bones or lungs

You may need to have more intensive treatment if you have any of the following

  • Large areas of lymphoma (bulky disease)
  • Lymphoma spreading outside the lymph system
  • Symptoms such as heavy sweating at night, a high temperature that comes and goes (often at night), or weight loss. 

Hodgkin lymphoma that comes back

If your Hodgkin lymphoma comes back after it has been treated, this is called recurrent disease. Your doctors will not stage it in the same way as when you were first diagnosed.

 

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

 

The stages of Hodgkin lymphoma

The stage of the cancer means whether your cancer is localised in one area of the body or is in more than one area. 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. There is general information about the stages of cancer in our section on cancer in general.

  • Stage 1 means there is Hodgkin lymphoma in only 1 group of lymph nodes or lymphoma in 1 body organ only

Diagram showing stage 1 Hodgkin's lymphoma

  • Stage 2 means Hodgkin lymphoma in 2 or more groups of lymph nodes or 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

Diagram showing stage 2 Hodgkin's lymphoma

  • Stage 3 means Hodgkin lymphoma on both sides of the diaphragm

Diagram showing stage 3 Hodgkin's lymphoma

  • Stage 4 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's lymphoma

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.

If you have a lymph node that is bigger than 10cm, or a widening of the mediastinum, or lymphoma in lymph nodes in the mediastinum area, doctors call this bulky disease. The mediastinum is the area at the centre of the chest containing the heart and blood vessels. 

If you have lymphoma spreading outside the lymph system, your doctors will put the letter E after your stage – this stands for extranodal extension. This means the lymphoma has spread outside of the lymphatic system and bone marrow. If the spleen is affected the letter S will be put after the stage.

 

Symptoms

As well as using your test results to work out the stage of the Hodgkin lymphoma, your doctors will ask you about your symptoms. The letter B will be put after your stage if you have any of the following

  • Heavy sweating at night
  • High temperature that comes and goes, often at night
  • Unexplained weight loss (more than a tenth of your total weight)

If you do not have any of these symptoms, the letter A will be put after your stage. So you could have stage 2A if you have Hodgkin lymphoma in 2 groups of lymph nodes on the same side of the diaphragm but no general symptoms.

Doctors take your symptoms into account because they have found out from experience that the treatment may need to be different for people with B symptoms. Sometimes people with these symptoms need more treatment than people without them.

 

Early stage Hodgkin lymphoma

Early stage Hodgkin lymphoma means stage 1 or 2 lymphoma with no bulky disease. There are some factors that mean the outlook is very good (favourable). These factors include the following

  • 3 or less lymph node areas affected
  • A low red blood cell settling rate – erythrocyte sedimentation rate (less than 50mm per hour)
  • Age 40 or younger
  • No B symptoms
  • No bulky disease
 

Advanced stage Hodgkin lymphoma

Advanced stage Hodgkin lymphoma means any stage with bulky disease, stage 2 with B symptoms, stage 3 or stage 4. The lymphoma may be a bit more difficult to treat in people who have the following factors known as modifying features.

  • B symptoms
  • Bulky disease
  • Lymphoma outside the lymph system (extralymphatic disease)
  • Low blood protein levels (serum albumin)
  • Low red blood cell levels
  • Men
  • Older than 45
  • High numbers of white blood cells called leukocytes
  • Low numbers of white blood cells called lymphocytes
 

Hodgkin lymphoma that comes back

If your Hodgkin lymphoma comes back after it has been treated, this 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 be effective.

If you would like more information about anything to do with how to stage your Hodgkin lymphoma, contact one of the organisations on our Hodgkin lymphoma organisations page. They will be happy to help. They often have free factsheets and booklets they can send to you.

You can also contact our cancer information nurses. They would be happy to help.

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Updated: 13 June 2013