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About Lymphoma > Stage (Staging Lymphomas)

Last update: 08/31/2014

Staging | Extranodal notations | Ann Arbor notations | About Stage IV  | In the News

Staging defines how widespread the disease is and the locations of the disease in the body.  

Above illustration adapted from Favrille patient education material.

Click to enlarge illustration

Ann Arbor staging for Lymphoma:

NOTE: The staging does not take into account the grade (growth rate) of the tumor tissue, or prognostic factors, such as bulky disease, LDH, age, symptomatic.  See FLIPI

Bone marrow involvement and other so-called extranodal involvement is not unexpected for lymphoma can be reversed with treatment.


Stage I - disease in single lymph node or lymph node region.


Stage II - disease in two or more lymph node regions on same 
side of diaphragm. 

Note: Stage II contiguous means two or more lymph nodes in close proximity (side by side).


Stage III - disease in lymph node regions on both sides of the 
diaphragm are affected. 


Stage IV - disease is wide spread, including multiple involvement at 
one or more extranodal (beyond the lymph node) sites, such as the
bone marrow (which is involved commonly), liver, pleura (thin lining of the lungs).

Also see Extranodal and Ann Arbor notations  below,
which may be added to the above staging designations.

Also see

Prognostic Factors (FLIPI, IPI, MIPI) PAL
CLL Staging (Rai | Binet)
Staging  Cancer.org
Staging  Oncologychannel.com
Value of PET imaging in Follicular Lymphoma: Discussion http://www.medscape.com/viewarticle/583796_4

In the News and Updates

Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and NHL The Lugano Classification http://bit.ly/1pwwzEF
Dr. Sharman's CLL & Lymphoma Blog
Follicular Lymphoma Grade and Stage http://bit.ly/17o8Kkl


CLL Staging (Rai | Binet)

MALT Staging and Workup - PAL

lymphoma-sites.gif (37953 bytes)Extranodal notations 

Extranodal means 'beyond nodal' -  sites are identified by the following notation: 

N    = lymph nodes 
  E  = extranodal
  H    = liver (hepatic)
  L   = lung
  M  = bone marrow 
  S    = spleen 
  P   = pleura (lung) 
  O  = bone 
  D  = skin (dermis)

You can click the image on the right to enlarge it.

Disease Staging may also be accompanied by local involvement of an extranodal organ or site.
Example involving spleen: Stage IIIS

ANN ARBOR notations 

Ann Arbor staging further classifies patients with lymphoma into A or B categories

A = without symptoms

B = with symptoms including unexplained weight loss (10% in 6 months prior to diagnosis,  unexplained fever, and drenching night sweats.) 

E = Extranodal means 'beyond nodal' (see above)
Disease Staging may also be accompanied by local involvement of an extranodal organ or site.
Example involving spleen and Ann Arbor notation: Stage IIIS A


It is common for b-cell lymphomas to be diagnosed at stage IV, and with bone marrow involvement.  While dependant on the cell type and other factors, successful treatment is often possible for stage IV disease and bone marrow involvement is reversible!

Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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