Non-Hodgkin Lymphoma: Stages

Once your healthcare provider knows you have non-Hodgkin lymphoma (NHL), the next step is to find out the stage of the cancer. The stage tells where the cancer is and if it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. Scans can also show if the cancer has spread to nearby areas or other parts of your body. The stage is one of the most important things to know when deciding how to treat NHL.

The staging system used for NHL is called the Lugano classification. It has four stages. It uses Roman numerals I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is.

A letter E may be added after the Roman numeral. It means the lymphoma has been found in an organ outside the lymph system (an extranodal organ). An E might be added in stages I or II to mean NHL is also in the liver or a lung.

These are the stage groupings of NHL and what they mean:

Stage I is either of these:

• Stage I. The cancer is in one group of lymph nodes or one organ that's part of the lymph system, like the tonsils.

• Stage IE. The cancer is found only in one part of one organ outside of the lymph system.

Stage II is either of these:

• Stage II. The cancer is in two or more groups of lymph nodes, either above or below your diaphragm. The diaphragm is the thin sheet of muscle under your ribs that separates your chest and your belly (abdomen).

• Stage IIE. The cancer is in one organ and one or more groups of lymph nodes on the same side of the diaphragm.

Stage III is either of these:

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

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

Stage IV is when the lymphoma is widely spread in at least one organ outside the lymph system, like the bone marrow, liver, or lung.

NHL may be called "bulky disease" if there are big tumors or big groups of affected lymph nodes in the chest. In this case, more intense treatment may be needed.

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand. Ask any questions and talk about your concerns.