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Cancer Staging Systems

Staging of Non-Hodgkin's Lymphoma

The Ann Arbor staging system is commonly used for patients with NHL. The stages are further subclassified into A and B categories: B for those with well-defined generalized symptoms and A for those without. The B designation is given to patients with any of the following symptoms:

• Unexplained loss of more than 10% of body weight in the 6 months before diagnosis.
• Unexplained fever with temperatures above 38 degrees C.
• Drenching night sweats.

Stage I

Involvement of a single lymph node region (I) or localized involvement of a single extralymphatic organ or site (IE).

Stage II

Involvement of 2 or more lymph node regions on the same side of the diaphragm (II) or localized involvement of a single associated extralymphatic organ or site and its regional lymph nodes with or without other lymph node regions on the same side of the diaphragm (IIE).

Stage III

Involvement of lymph node regions on both sides of the diaphragm (III) that may also be accompanied by localized involvement of an extralymphatic organ or site (IIIE), by involvement of the spleen (IIIS), or both (IIIS+E).

Stage IV

Disseminated (multifocal) involvement of 1 or more extralymphatic sites with or without associated lymph node involvement or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement.

The designation E is used when extranodal lymphoid malignancies arise in tissues separate from, but near, the major lymphatic aggregates. Stage IV refers to disease that is diffusely spread throughout an extranodal site, such as the liver.

Sites are identified by the following notation:

• N = nodes
• H = liver
• L = lung
• M = bone marrow
• S = spleen
• P = pleura
• O = bone
• D = skin

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References

1. Lymphoid neoplasms. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 393-406. 

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