Staging of Hodgkin lymphoma

The stage describes how many areas of the body are affected by lymphoma and where these are.

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What is staging?

Knowing the extent of the lymphoma helps your doctor plan the right treatment. This is called staging.

Your doctor will also ask you about any symptoms you have. All this information helps doctors plan the right treatment for you.

Staging of lymphoma can sometimes be complicated. Your doctor or specialist nurse will explain what stage you have.

Number staging

The stage of a lymphoma is usually described using numbers from 1 to 4. Stages 1 and 2 are sometimes called early stage (limited or localised lymphoma). Stages 3 and 4 are sometimes called advanced lymphoma. In some situations, stage 2 lymphoma that is large (bulky – see below) is treated as advanced disease.

Stage 1

The lymphoma is either:

  • in a single lymph node, one group of lymph nodes, or in one organ of the lymphatic system, such as the tonsils
  • or in another part of the body outside the lymph system (extra-nodal – see below).

Stage 1 – Lymphoma in a single group of lymph nodes

The body’s lymph nodes are shown. 4 nodes in the neck and 4 under the arm are highlighted to show there is lymphoma in these 2 areas.
Image: The diagram shows the outline of a front facing body with a side view of the head. There is a band just below the lungs that goes all the way across the upper chest. This is the diaphragm. The lungs are lightly outlined with one on either side of the chest. In the neck on the left side of the diagram below the ear there is a group of small round lymph nodes. These are highlighted to show there is lymphoma in this area. On the left side of the diagram in the area under the arm at the shoulder there is another group of lymph nodes. These are also highlighted to show there is lymphoma in this area. There is a light outline of lots of other groups of lymph nodes shown throughout the body. They connect to each other through a network of fine tubes. There is no lymphoma in these nodes.

Stage 2

The lymphoma is either:
  • in two or more groups of lymph nodes
  • or in another part of the body (extra-nodal) and in one group of lymph nodes.

For both these, the sites of lymphoma are on the same side of the diaphragm – either above or below it. The diaphragm is the sheet of muscle underneath the lungs that separates the chest from the tummy (abdomen).

Stage 2 – Lymphoma in 2 groups of lymph nodes

Lymphoma in two groups of lymph nodes
Image: The diagram shows the outline of a front facing body with a side view of the head. There is a band just below the lungs that goes all the way across the upper chest. This is the diaphragm. The lungs are lightly outlined with one on either side of the chest. In the neck on the left side of the diagram below the ear there is a group of small round lymph nodes. These are highlighted to show there is lymphoma in this area. On the left side of the diagram in the area under the arm at the shoulder there is another group of lymph nodes. These are also highlighted to show there is lymphoma in this area. There is a light outline of lots of other groups of lymph nodes shown throughout the body. They connect to each other through a network of fine tubes. There is no lymphoma in these nodes.

Stage 3

There are areas of lymphoma above and below the diaphragm.

Stage 3 – Lymphoma in 2 groups of lymph nodes, above and below the diaphragm

The body’s lymph nodes are shown. 4 nodes in the neck and 4 in the groin are highlighted to show there is lymphoma in these 2 areas.
Image: The diagram shows the outline of a front facing body with a side view of the head. There is a band just below the lungs that goes all the way across the upper chest. This is the diaphragm. The lungs are lightly outlined with one on either side of the chest. In the neck on the left side of the diagram below the ear there is a group of small round lymph nodes. These are highlighted to show there is lymphoma in this area. On the left side of the diagram at the top of the thigh there is another group of lymph nodes. These are also highlighted to show there is lymphoma in this area.

Stage 4

There are areas of lymphoma outside and separate from the lymphatic system. For example, this could be in organs such as the bone marrow, lungs or liver.

Stage 4 – Lymphoma has also spread to the lung and bone marrow

The body’s lymph nodes are shown. Lymphoma is shown in 4 nodes in the neck, 4 nodes in the groin, a lung and bone marrow in the hipbone.
Image: The diagram shows the outline of a front facing body with a side view of the head. There is a band just below the lungs that goes all the way across the upper chest. This is the diaphragm. The lungs are shown with one on either side of the chest. The outline of the lung on the left side of the diagram is highlighted to show there is lymphoma in this area. In the neck on the left side of the diagram below the ear there is a group of small round lymph nodes. These are highlighted to show there is lymphoma in this area. On the left side of the diagram at the top of the thigh there is another group of lymph nodes. These are also highlighted to show there is lymphoma in this area. On the right side of the diagram at the top of the thigh is the outline of the hipbone (femur). The centre of the upper part of the bone is shaded to show the bone marrow. The shading is used to show that there is lymphoma in the bone marrow.

Extra-nodal lymphoma

Lymphoma is sometimes found in parts of the body outside the lymph nodes. This is called extra-nodal lymphoma. Extra-nodal sites include the liver, lungs, spinal cord and bone marrow.

Extra-nodal lymphoma is described by adding the letter E (for extra-nodal) after the stage number. For example, the lymphoma may be described as 1E.

If you have extra-nodal lymphoma, your doctor can explain to you how this affects the stage.

Bulky disease

This term is used to describe:

  • an area of HL that is 10cm (4 inches) or more in diameter
  • a tumour in the centre of your chest (mediastinum) that is at least a third of the width of your chest.

The letter X may be added after the stage number. For example, the lymphoma may be described as 1X.

B symptoms

Sometimes the letter B is added after the stage number. For example, the lymphoma may be described as stage 1B. This is used to show if you have any symptoms that doctors call B symptoms. The B symptoms are:

  • heavy drenching night sweats
  • unexplained high temperatures
  • unexplained weight loss.

If you have any B symptoms, it usually means the lymphoma is more advanced. If you do not have any of these symptoms, the letter A is used instead, for example stage 1A.

About our information

  • References

    Below is a sample of the sources used in our Hodgkin lymphoma (HL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2018).

    National Institute of Health and Care Excellence (NICE). Blood and bone marrow cancers. NICE Pathways. Last accessed 3 December 2020.

Reviewers

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.


Date reviewed

Reviewed: 01 March 2021
|
Next review: 01 March 2024

This content is currently being reviewed. New information will be coming soon.

Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.

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