Staging non Hodgkin's lymphoma

This page tells you about the stages of non Hodgkin's lymphoma. There is more information on

A quick guide to what's on this page
What staging is
How NHL is staged
Stages of NHL made simple

Staging non Hodgkin’s lymphoma

Staging is important because your doctor uses the stage to work out the treatment you will need. There are 4 stages of non Hodgkin's lymphoma

Stage 1 - you have one group of lymph nodes affected or lymphoma just in one organ of the body
Stage 2 - you have 2 or more groups of lymph nodes affected or an organ and one or more group of lymph nodes, but these are on the same side of your diaphragm
Stage 3 - you have lymph nodes affected on both sides of the diaphragm
Stage 4 - your lymphoma has spread outside the lymph nodes, for example, to the liver, bones or lungs

If you have night sweats, a high temperature that comes and goes, or weight loss (more than one tenth of your total weight), the letter 'B' will be put after your stage. If you do not have any of these symptoms, the letter 'A' will be put after the stage. Sometimes people with B symptoms need more treatment than people without them.

Stages of NHL made simple

In practice, to work out what treatment you need, doctors classify NHL as either limited or advanced. Limited means stage 1 or 2, type A, and with all tumours less than 10cm across. Advanced means stage 3 or 4, or type B, or any tumour more than 10 cm across.

The 'stage' of the cancer means whether it is localised or has spread. The tests and scans you have to diagnose your lymphoma will give some information about the stage. Your doctor uses the stage to work out the treatment you will need. There is more general information about the stages of cancer in the about cancer section of CancerHelp UK.

There are 4 stages of non Hodgkin's lymphoma

Stage 1 - you have one group of lymph nodes affected

or lymphoma just in one organ of the body
Stage 2 - you have 2 or more groups of lymph nodes affected

or an organ and one or more groups of lymph nodes, but these are on the same side of your diaphragm
Stage 3 - you have lymph nodes affected on both sides of the diaphragm
Stage 4 - your lymphoma has spread outside the lymph nodes, for example, to the liver, bones or lungs

The diaphragm (pronounced 'diafram') is a sheet of muscle just under the rib cage. The diagram shows you where it is.

Diagram showing the position of the diaphragm and the lymph nodes NHL may develop in

Doctors use the diaphragm as a reference point for working out the stages of non Hodgkin's lymphoma because it is about half way down the body.

As well as using your test results to work out the stage of the non Hodgkin's lymphoma, your doctors will ask you about your symptoms. If you have any of these symptoms

Night sweats
A high temperature that comes and goes
Weight loss (more than one tenth of your total weight)

the letter 'B' will be put after your stage. If you do not have any of these symptoms, the letter 'A' will be put after the stage. So, if you have

Two groups of lymph nodes affected on the same side of the diaphragm
Temperatures and sweats

you have a Stage 2B non Hodgkin's lymphoma.

Doctors take your symptoms into account because they have found out that the treatment may need to be different for people with B symptoms. Sometimes people with B symptoms need more treatment than people without them.

In practice, to work out what types of treatment you need, doctors put people with non Hodgkin's lymphoma into two groups for staging. They call these groups

Limited
Advanced

This is how the groups are made up

Limited

Stage 1 or 2

and

Type 'A'

and

All tumours smaller

than 10 cm across

Advanced

Stage 3 or 4

or

Type 'B'

or

Any tumour bigger

than 10 cm across

So, you have limited stage disease if you have non Hodgkin's lymphoma only on one side of your diaphragm and

Small tumours
And no 'B' symptoms (night sweats, temperatures or weight loss)

You have advanced stage disease if you have non Hodgkin's lymphoma on both sides of your diaphragm

Or a tumour of more than 10cm
Or any of the 'B' symptoms

If you would like more information about staging non Hodgkin's lymphoma, contact one of the organisations listed on the non Hodgkin's lymphoma organisations page. They will be happy to help. They often have free factsheets and booklets which they can send to you.