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Stages of Hodgkin lymphoma

The stages of Hodgkin lymphoma (HL) tell you about the number and places in the body that are affected by lymphoma.

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

The Lugano classification is used to stage lymphoma. There are 4 stages. Or these can be simplified into limited (early) or advanced stage. 

How doctors work out your stage

Doctors look at whether the lymphoma is on one side, or both sides of the diaphragm. And whether it is inside or outside of the lymphatic system. They will measure the size of the lymphoma. They do this by carrying out various tests, such as a CT or PET scan. They will also check whether you have any symptoms.

The diaphragm

The diaphragm (pronounced dia-fram) is the big breathing muscle that separates the chest from the tummy (abdominal) area. 

Doctors use the diaphragm as a guide because it is about halfway down the body.

Inside or outside of the lymphatic system

Doctors look at whether the lymphoma is affecting:

  • the nodes and organs of the lymphatic system – these are called lymphatic sites
  • areas outside of the lymphatic sites – called extranodal (or extralymphatic) sites

Lymphatic sites include a group of lymph nodes or an organ of the lymphatic system, such as the thymus or spleen.

Extranodal sites include the lungs, liver, blood, bone marrow, kidneys, brain and spinal cord. 

Your doctor may use the letter E after the stage number if you have lymphoma outside of the lymphatic system. Your doctor or nurse can explain what this means in your situation.

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
Diagram showing Lymph nodes and organs of the lymphatic system

Stage 1

This means that you have one of the following:

  • lymphoma in a single lymph node or one group of lymph nodes, or an organ of the lymphatic system (such as the thymus)
  • lymphoma in an extranodal site (1E)

Below is an example of stage 1 lymphoma. 

Diagram showing example of stage 1 lymphoma

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

Stage 2

This means one of the following:

  • your lymphoma is in two or more groups of lymph nodes
  • your lymphoma is in an extranodal site and one or more groups of lymph nodes (2E)

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

Below is an example of stage 2.

Diagram showing example of stage 2 lymphoma

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

Stage 3

This means that you have lymphoma on both sides of the diaphragm.

One example is that the lymphoma is in lymph nodes on both sides of the diaphragm. Another example (see below) is that the lymphoma is in lymph nodes above the diaphragm, as well as lymphoma in the spleen.

Diagram showing example of stage 3 lymphoma

Treatment for stage 3 Hodgkin lymphoma, is generally between 6 to 8 cycles of chemotherapy. You might have steroids as part of this. And you may also have radiotherapy.

Stage 4

Stage 4 means one of the following:

  • your lymphoma is in an extranodal site and lymph nodes are affected
  • your lymphoma is in more than one extranodal site, for example the liver, bones or lungs

Below is an example of stage 4 lymphoma.

Diagram showing example of stage 4 lymphoma

Treatment for stage 4 Hodgkin lymphomais usually between 6 to 8 cycles of chemotherapy. You might have steroids as part of this. And you may also have radiotherapy.

These stages made simple

Your doctor may describe your lymphoma as being limited (early) or advanced stage.

Limited stage

Limited stage generally means you have stage 1 or stage 2A Hodgkin lymphoma.

Advanced stage

Advanced stage means you have stage 2B, 3 or stage 4 Hodgkin lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.

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: 
28 Feb 2018
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

  • 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

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

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