Staging and grading lymphoma
Knowing the extent of the lymphoma helps your doctor plan the right treatment. This is called staging. Lymphomas are also grouped as either low grade or high grade.
Staging lymphoma
Staging describes how many areas of the body are affected by lymphoma and where these are. 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 cancer doctor or specialist nurse will explain what stage you have.
Related pages
Number staging
The stage of a lymphoma is usually described using numbers from 1 to 4. Stages 1 and 2 are also called early stage, limited or localised lymphoma. Stages 3 and 4 are sometimes called advanced lymphoma.
Stage 1
The lymphoma is either:
- in 1 single lymph node or 1 group of lymph nodes
- in 1 part of the body outside the lymph nodes (extra-nodal).
Stage 1 – Lymphoma in a single group of lymph nodes
Stage 2
The lymphoma is either:
- in 2 or more groups of lymph nodes
- or in another part of the body (extra-nodal) and in 1 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 two 2 groups of lymph nodes
Stage 3
There are areas of lymphoma above and below the diaphragm.
Stage 3 – Lymphoma in two 2 groups of lymph nodes, above and below the diaphragm
Stage 4
The lymphoma is more widespread and may also affect organs such as the bone marrow, lungs or liver.
Stage 4 – Lymphoma has also spread to the lung and bone marrow
Extra-nodal lymphoma
Lymphoma in parts of the body outside the lymph nodes 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 stage 1E.
Bulky disease
If an area of lymphoma is large, it is often called bulky disease.
The letter X may be added after the stage number to show bulky disease. For example, the lymphoma may be described as stage 1X.
B symptoms
Lymphoma B symptoms include:
- heavy, drenching sweats, especially at night
- unexplained high temperatures
- unexplained weight loss.
Doctors use information about B symptoms to help stage lymphoma and plan treatment. The letter B is added after the stage number to show you have B symptoms. For example, the lymphoma may be described as stage 2B. If you do not have any of these symptoms, the letter A is used instead, for example stage 2A.
Lymphoma in the spleen
The letter S may be added after the stage number to show there is lymphoma in the spleen. For example, the lymphoma may be described as 1S.
Grading non-Hodgkin lymphoma (NHL)
Grading describes how and how quickly the lymphoma cells are likely to grow.
For some types of non-Hodgkin lymphoma (NHL), this information helps doctors plan the right treatment for you.
Low grade lymphomas
These grow very slowly. They are sometimes called indolent or chronic lymphomas. They may need little or no treatment for months or possibly years. Some people will never need treatment. Follicular lymphoma (FL) is the most common type of low grade NHL.
High grade lymphomas
These grow more quickly and are sometimes called aggressive lymphomas. They usually cause symptoms and need immediate treatment. Diffuse large B-cell lymphoma (DLBCL) is the most common type of high grade lymphoma.
About our information
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.
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References
Below is a sample of the sources used in our lymphoma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Follows GA, Barrington SF, et al. Guideline for the first-line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline. Br J Haematol, 2022; 197, 558– 572. [accessed April 2024].
Fox CP, Chaganti S, McIlroy G, et al. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024; 204(4):1178–92. [accessed April 2024].
McKay P, Fielding P, et al. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol, 2015; 172, 32-43. [accessed April 2024].
McNamara C, Montoto S, et al. The investigation and management of follicular lymphoma. Br J Haematol, 2020; 191, 363-381. [accessed April 2024].
National Institute for Health and Care Excellence. Non-Hodgkin’s lymphoma: diagnosis and management. NICE guideline [NG52]. Published: 20 July 2016. Last update Oct 2021. [accessed April 2024].
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