Back to basics
Staging of lymphoma
‘Staging’ is the process of working out what parts of the body are affected by lymphoma. Staging helps doctors plan treatment.
How is lymphoma staged?
Tests and scans are used to work out where in the body the lymphoma is and to find out how it is affecting you.
The same staging system is used for most Hodgkin and non-Hodgkin lymphomas.
This is called the ‘Lugano’ classification system. However, there are a few exceptions:
- non-Hodgkin lymphoma in children is staged slightly differently from adults.
- chronic lymphocytic leukaemia (CLL) uses a different system.
- skin (cutaneous) lymphomas (lymphomas that start in the skin) behave differently from other lymphomas and are staged depending on whether they are B-cell skin lymphomas or T-cell skin lymphomas.
- Waldenström’s macroglobulinaemia (WM) does not often affect the lymph nodes, and is staged by giving a score between 0 and 5, which is based on age and blood test results.
The Lugano classification system
The Lugano staging system is based on where the lymphoma is in the body in relation to the diaphragm (the sheet of muscle separating your chest from your tummy, which is roughly halfway down your body). There are four main stages of lymphoma. These are numbered 1 to 4, sometimes written in Roman numerals as I to IV. Doctors might talk about ‘early’ stage or ‘advanced’ stage lymphoma, which is a simplified version. ‘Early’ (or ‘limited’) generally means stage 1 or 2, and ‘advanced’ means stage 3 or 4.
Stage 1 means that there is lymphoma in only one group of lymph nodes (glands). The diagram shows these in the neck, but they can be anywhere in the body, either above or below the diaphragm.
Stage 2 means there is lymphoma in two or more groups of lymph nodes. These can be anywhere in the body but they must all be on the same side of the diaphragm (either above or below).
Stage 3 means there are lymph nodes that contain lymphoma on both sides of the diaphragm.
Stage 4 means that lymphoma that started in the lymph nodes has spread to at least one organ outside the lymphatic system (for example, the lungs, liver, bone marrow or solid bones). The spleen and the thymus are part of the lymphatic system, so lymphoma in those organs only is not stage 4.
Letters after the stage
A letter might also be given after the stage number. These letters give additional information:
- ‘A’ means none of the following ‘B’ symptoms are present.
- ‘B’ means that you have one or more B symptoms: unexplained significant weight loss (more than 10% of your usual body weight), drenching night sweats or fevers (temperatures above 38°C).
- ‘E’ stands for ‘extranodal’ and means that the lymphoma started in a body organ that is not part of the lymphatic system, for example, in the digestive system or in the salivary glands.
- ‘S’ means there is lymphoma in the spleen.
- ‘X’ means that one or more of the affected lymph nodes is considered to be large or ‘bulky’.
Why is staging important?
Staging lymphoma is important because it helps your medical team plan the most appropriate treatment for you. Different types and stages of lymphoma respond to different treatments. It is common for lymphoma to be at an advanced stage when it is diagnosed. This is because the lymphatic system runs throughout the body. Unlike some other types of cancer, being diagnosed at a late stage does not mean that there is less treatment available. There is effective treatment for most types of lymphoma, including those at an advanced stage.
“I was diagnosed with Hodgkin lymphoma stage 4A. It was explained that it was stage 4 because the lymphoma was in my neck, the right side of my chest and had spread out of my lymph system into my lung. It was a shock to hear it was stage 4, but it felt like we could now get on and tackle the problems rather than it hanging over us.
Want to read stories from people like you?
We are so grateful to all the people who generously share their stories. They talk about how they have been affected by lymphoma and how they coped with their diagnosis, treatment and living with and beyond lymphoma.
To find stories on our website that are most relevant to you use the drop down filter. You can search categories you may find useful, for example types of lymphoma, treatments or caring for someone with lymphoma.
