Stages of Hodgkin’s Lymphoma

Summary

Based on the Lugano classification derived from the Ann Arbor stage system, Hodgkin’s lymphoma can be classified into Stage I, II, III, and IV where Stage I denotes early stage and Stage IV denotes advanced stage. In addition to the stage numbers, the HL stage can be further classified using the letters A, B, E or S.

Introduction

After a person is diagnosed with lymphoma, doctors determine the stage of the disease or the spread of cancer and then develop a treatment plan. Like most cancers, lymphoma usually has four distinct stages: I, II, III, and IV.

The determination of Hodgkin’s lymphoma stage is based on the Lugano classification derived from the Ann Arbor stage system.

Stage I Hodgkin’s lymphoma

HL cells located in the area of ​​one lymph node (which may contain one node or a group of adjacent nodes), or

HL cells are located in organs or sites outside the lymphatic system.

Stage II Hodgkin’s lymphoma

HL cells located in the lymph node area on the same side of the diaphragm (the thin muscle below the lungs and the heart that separates the abdomen and chest) above or below the diaphragm, or

HL cells are located in the lymph node area on the same side of the diaphragm and in nearby organs outside the lymphatic system.

Stage III Hodgkin’s lymphoma

HL cells located in the lymph node area on both sides of the diaphragm (upper and lower), possibly with local involvement of the lymphatic system or organs outside the spleen.

Stage IV Hodgkin’s lymphoma

HL cells are widely distributed in one or more organs outside the lymphatic system.

Categories

The HL stage can be further classified using the letters A, B, E or S.

  • Category A: The patient has no B symptoms (fever, weight loss or night sweats).
  • Category B: Patient with B symptoms.
  • Category E: HL cells in organs or tissues outside the patient’s lymphatic system.
  • Category S: The patient’s spleen contains HL cells.

For example, stage IIB indicates that the patient has:

Involvement of two lymph node areas close to each other (e.g. enlarged lymph nodes in the neck and armpits).

Fever, excessive sweating and / or weight loss.

Category B patients sometimes require more aggressive treatment. It is to be noted that patients with stage IV (advanced stage) HL often recover after treatment, despite the presence of hodgkin’s lymphoma in many parts of the body​1,2​.

References

  1. 1.
    HODGKIN LYMPHOMA STAGING. Leukemia & Lymphoma Society. Accessed March 2022. https://www.lls.org/lymphoma/hodgkin-lymphoma/diagnosis/hodgkin-lymphoma-staging
  2. 2.
    LaCasce AS. Stage IV Lymphoma and the Stages of Lymphoma: What You Need to Know. Dana-Farber Cancer Institute. Published 2019. Accessed March 2022. https://blog.dana-farber.org/insight/2017/12/different-stages-lymphoma/