What Are the Stage Classifications of Non-Hodgkin's Lymphoma?

Non-Hodgkin’s lymphoma is a type of cancer that develops in the lymphatic system of the body. The lymphatic system is a disease fighting network that is spread throughout the body. In this particular type of cancer, the cancerous tumors develop from lymphocytes, a type of white blood cell.

When determining treatment options for non-Hodgkin’s lymphoma, doctors first determine what types of lymphocytes are involved. Whether the cancer developed from B or T cell lymphocytes determines the specific approaches of chemotherapy, radiation therapy and other courses of treatment.

Another factor in determining treatment options is the determination of how advanced the cancer is in its growth. This determination involves assigning a stage classification to mark the stage of development of the lymphoma.

Stages of Development

Stage I is the earliest stage of growth progressing through Stage IV. The stage determinations are made based on the number of tumors and how widely the tumors have spread throughout the body.

Stage I: Lymphomas present in a single lymphatic site (i.e., spleen, lymph node) OR in a single non-lymphatic site or organ. The latter is a rarity in non-Hodgkin’s lymphoma.

Stage II: Two or more lymph nodes on the same side of the diaphragm are involved or a single region of lymph nodes affected along with a single non-lymphatic organ.

Stage III: Lymphatic regions on both sides of the diaphragm are affected. This stage can also be accompanied by lymph node involvement outside the main concentration and/or the spleen.

Stage IV: Spread out cancers of one or more non-lymphatic organs with or without lymph node region involvement or tumors isolated to a single non-lymphatic organ but including additional diseases in other places. Examples of the second part of the classification include any involvement of the liver, bone marrow or cerebrospinal fluid.

Sub-Classification: Ann Arbor System

There is a sub-classification of staging definitions known as the Ann Arbor system. In this staging system, Stages I through IV are subdivided into categories A and B. Category B is for patients who present well defined generalized systems and Category A is for those who do not display such systems.

The B sub-category is assigned to patients who show any of the following symptoms:

• Drenching night sweats
• Fever with no explanation above 100.4 degrees Fahrenheit
• Unexplained loss of greater than 10% of body weight in the 6 months prior to diagnosis.

Stages of non-Hodgkin’s lymphoma are further categorized by area of the lymph node system or organ affected, method of testing used to identify the cancer and whether the stage was identified through a clinical diagnosis (CS) or from invasive pathological procedures (PS).

Testing Methods

The testing methods used to determine the spread and type of cancerous cells involved can include one or more of the following:

• physical examination
• blood and urine testing
• imaging tests such as PET scans or X-rays
• biopsies of lymph nodes or bone marrow samples

The combination from the results of all tests is used to give the clearest determination of staging and type of cancerous cells to determine the most effective treatment method(s).

Predicting Non-Hodgkin's Lymphoma

Various studies have been conducted to develop predictive staging definitions of non-Hodgkin’s lymphoma. This means that given a patient’s age, type of cancerous cells, stage of tumor spread as explained above and other factors, stage definition can be assigned to predict chance of survival within a percentage range. This allows physicians to determine the need for more aggressive treatment regimens and/or specific treatments.

Staging classifications of non-Hodgkin’s lymphoma are important for treatment and prediction. They allow:

• Standardized best treatment practices based on many cases of data
• Physicians to predict survival chances and disease progression to best inform the patient so that decisions regarding care and personal matters can be made

Precise staging classification is also of importance regarding data collection and recording so that future research can accurately use any given data in developing new cancer fighting methods. The non-Hodgkin’s lymphoma staging system is completed by necessity but of great necessity in its application.