Staging and grading of Non-Hodgkin lymphoma (NHL)

Knowing the extent of the lymphoma helps your doctor plan the right treatment. This is called staging. Lymphomas are also often grouped as either low-grade or high-grade.

Staging of non-Hodgkin lymphoma (NHL)

The stage describes how many areas of the body are affected by lymphoma and where these areas are. This information helps doctors plan the right treatment for you.

Number staging

The stage of a lymphoma is usually described using numbers from 1 to 4.

  • Stage 1

    There is one area of lymphoma only. This may be one group of lymph nodes or another part of the body (see ‘extra-nodal’ below).

  • Stage 2

    There are 2 or more areas of lymphoma on the same side of the diaphragm (the sheet of muscle underneath the lungs).

  • Stage 3

    There are areas of lymphoma above and below the diaphragm.

  • Stage 4

    The lymphoma is more widespread and may also affect organs such as the bone marrow, liver or lungs.
    Stages 1 and 2 are also called early-stage, limited or localised lymphoma. Stages 3 and 4 are also called advanced lymphoma.

B symptoms

If you have any B symptoms, the letter B is added after the stage number, for example stage 1B. The B symptoms are:

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

If you do not have any of these symptoms, the letter A is used instead, for example stage 1A.

Bulky disease

If an area of lymphoma measures 10cm (4 inches) or more across this is called ‘bulky’ disease. The letter X may be added after the stage number, for example stage 1X.

Extra-nodal lymphoma

Sometimes lymphoma is found in parts of the body outside the lymph nodes. This is called extranodal lymphoma.

It is described by adding the letter E (for extranodal) after the stage number, for example 1E.

The staging of extranodal lymphoma depends on whether the lymphoma:

  • started in an organ outside the lymph nodes - this is called primary extranodal NHL
  • started in the lymph nodes and then spread somewhere else.

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

Grading of non-Hodgkin lymphoma (NHL)

Lymphomas are also often grouped as either low-grade or high-grade.

Low-grade lymphomas (sometimes called indolent)

These grow very slowly and 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 sometimes called aggressive

These grow more quickly. 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

  • References

    Below is a sample of the sources used in our non-Hodgkin lymphoma (NHL) information. If you would like more information about the sources we use, please contact us at

    National Institute for Health and Care Excellence (NICE). Guideline NG46. Haematological cancers: improving outcomes. 2016.

    National Institute for Health and Care Excellence (NICE). Guideline NG52. Non-Hodgkin’s lymphoma: diagnosis and management. 2016.

    Treleaven, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. British Journal of Haematology. 2011.

  • 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 Editors, Dr Anne Parker, Consultant Haematologist; and 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.