Hodgkin Lymphoma: Stages

What does the stage of cancer mean?

The stage of a cancer is how much cancer there is and how far it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the tumor and where it is. Imaging scans can also show if it's growing into nearby areas or affecting other parts of your body. Hodgkin lymphoma usually starts in the lymph nodes. It then spreads to nearby groups of lymph nodes before growing into organs. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The Lugano classification for Hodgkin lymphoma

The system used for Hodgkin lymphoma has four stages. Each stage is listed as a Roman numeral and can have a value of I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is.

A letter may also be added after the Roman numeral to give more information. Here's what the letters mean:

• B is added if you have any of these symptoms (called B symptoms):

  • Unexplained fever of at least 100.4°F (38°C)

  • Drenching night sweats

  • Weight loss of more than 10% of total body weight over the previous 6 months, without trying

• A means you don’t have any B symptoms.

• E (extralymphatic) means the lymphoma has spread to an organ outside the lymphatic system. This is rare.

• X is added if you have bulky disease. This means that a tumor in your chest is at least 1/3 as wide as your chest. Or tumors in other areas are more than about 10 cm (4 inches) across. This is very important for stage II lymphomas because bulky disease may mean you need more intensive treatment.

What are the stage groupings of Hodgkin lymphoma?

The stage groupings of Hodgkin lymphoma are:

Stage I. The cancer is one of these:

• The lymphoma is in only 1 group of lymph nodes, or it's in 1 organ where lymphatic tissue is found, like the thymus (stage I).

• The cancer is only in 1 part of 1 organ outside the lymphatic system and hasn’t spread to any other part of the body (stage IE). This is rare.

Stage II. The cancer is one of these:

• The lymphoma is in 2 or more groups of lymph nodes on the same side of the diaphragm, either above or below it (stage II). The diaphragm is a thin sheet of muscle below the lungs and heart that separates your chest and your belly or abdomen.

• The cancer started in 1 group of lymph nodes and has spread into a nearby organ (stage IIE).

Stage III. The cancer is one of these:

• The cancer is in lymph nodes above and below the diaphragm.

• The cancer is in lymph nodes above the diaphragm and in the spleen.

Stage IV. The lymphoma has spread to 1 or more organs outside of the lymphatic system such as the liver, bone marrow, or lungs.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.