Non-Hodgkin’s lymphoma staging

Your doctor needs to know the extent (stage) of non-Hodgkin’s lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.

Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone and bone marrow.

Staging may involve one or more of the following tests:

  • Bone marrow biopsy: To remove a small sample of bone and bone marrow from your hipbone or another large bone with a large needle. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.
  • CT scan: To take a series of detailed pictures of your head, neck, chest, abdomen or pelvis with an X-ray machine linked to a computer. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the X-ray.
  • MRI: To make detailed pictures of tissue on a computer screen or film. MRI uses a powerful magnet linked to a computer.Your doctor may order MRI pictures of your spinal cord, bone marrow or brain.
  • Ultrasound: To make pictures of tissue inside your body. An ultrasound device sends out sound waves undetected by humans. A small hand-held device is held against your body, and the waves bounce off nearby tissues. A computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show possible tumors.
  • Spinal tap: To remove fluid from the spinal column to check for lymphoma cells or other problems. Local anesthesia can help control pain. You must lie flat for a few hours afterward so that you don’t get a headache.
  • PET scan: To make computerized pictures of the sugar being used by cells in your body. You receive an injection of a small amount of radioactive sugar. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.

The stage is based on where lymphoma cells are found   in the lymph nodes or in other organs or tissues. The stage also depends on how many areas are affected. The stages of non-Hodgkin’s lymphoma are as follows:

  • Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).
  • Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or the lymphoma cells are in one part of an organ and the lymph nodes are near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
  • Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.
  • Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or it is in the liver, blood or bone marrow.
  • Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

  • A: You have not had weight loss, drenching night sweats or fevers.
  • B: You have had weight loss, drenching night sweats or fevers.