Understanding the stage of non-Hodgkin lymphoma staging helps your care team determine how far the lymphoma has spread and which treatments are most appropriate. Several tests are run to gather the information that’s needed to make treatment decisions.
Tests Used to Determine Lymphoma Stages
Biopsy
A sample of the affected tissue will be removed and examined under a microscope by a pathologist. This doctor will confirm whether cancer is present and the type of cells where the cancer started – B-cells or T-cells. Other types of biopsies for lymphoma include bone marrow and cerebrospinal fluid to detect cancer cells once lymphoma is confirmed.
Imaging Tests
Imaging plays a critical role in staging. PET/CT scans are commonly used to determine the areas of the body where lymphoma cells are growing. CT scans and, in some cases, MRI scans may also be used to evaluate lymph nodes and organs.
Genetic Tests
Normal cells in your body have 23 pairs of chromosomes with a typical size and shape seen under a microscope. In some types of lymphoma, the cancer cells have extra or missing pieces of chromosomes, or rearranged chromosomes. These changes can be identified using several laboratory tests:
- Cytogenetic testing, also called karyotyping, examines the chromosomes in lymphoma cells to look for visible abnormalities, although the cells must first be grown in a lab. This means results may take a week or longer.
- Fluorescent in situ hybridization, known as FISH, uses special fluorescent dyes that attach to specific genes or chromosome segments, allowing doctors to detect most chromosome changes seen with standard cytogenetics, as well as smaller gene alterations that may not be visible under a microscope; results are often available within a few days.
- Polymerase chain reaction, or PCR, is a highly sensitive DNA test that can identify very small gene or chromosome changes, even when only a small number of lymphoma cells are present in the sample.
The oncologists at Blue Ridge Cancer Care will run these and other tests as needed to develop the right treatment plan for the type and extent of lymphoma.
Stages of Non-Hodgkin Lymphoma
Doctors typically use the Lugano classification system, which includes four stages – I to IV. The stage reflects how many areas of the body are involved and whether the disease is above or below the diaphragm.
Stage I
Stage I non-Hodgkin lymphoma means the lymphoma cells are found in only one lymph node area (such as the neck, armpit, or groin) or in a single organ or site outside the lymph nodes.
Stage II
Stage II means the lymphoma is in two or more lymph node areas, all on the same side of the diaphragm – either above or below the muscle that separates the chest from the abdomen. It can also mean the lymphoma started in one organ and has spread to nearby lymph nodes on the same side of the diaphragm.
Stage III
Stage III indicates that lymphoma is found in lymph node areas on both sides of the diaphragm. It may also involve the spleen or an organ near the affected lymph nodes.
Stage IV
Stage IV means the lymphoma has spread widely outside of the lymph nodes to one or more organs, such as the bone marrow, liver, or lungs. This stage reflects more extensive disease, but many types of non-Hodgkin lymphoma are still treatable, even at this stage.
Substages of Non-Hodgkin Lymphoma
Each stage may be followed by letters that provide more detail about the disease. While the main stages are I through IV, these added letters and descriptions help your oncology team more precisely define the extent of non-Hodgkin lymphoma and choose the most appropriate treatment plan.:
A and B designations
- An “A” means the person does not have certain systemic symptoms.
- A “B” means the person has one or more of the following symptoms:
- fever without infection
- drenching night sweats
- unexplained weight loss
E designation
An “E” stands for extranodal, meaning the lymphoma has spread to a nearby organ or tissue outside the lymph nodes.
S designation
An “S” means the lymphoma involves the spleen.
Bulky disease
Although not a formal letter substage, doctors may also describe lymphoma as bulky if a large tumor is present in the chest or another area.
What’s Next After Staging Non-Hodgkin Lymphoma?
The next phase after staging is to develop a personalized treatment plan based on all of the staging information. Blue Ridge Cancer Care provides the most advanced lymphoma treatments available today, right here in Southwest Virginia. You do not have to navigate large hospital campuses or travel long distances to receive precision cancer treatment. Our cancer centers make it possible to receive state-of-the-art treatment in one of our easily accessible and comfortable locations.
If you or a loved one was diagnosed with non-Hodgkin lymphoma, our experienced oncology team is here to guide you through staging, treatment options, and every step of your care journey.
