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STAGES OF ADULT NON-HODGKIN'S LYMPHOMA
After adult non-Hodgkin’s lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
The process used to find out the type of cancer and if cancer cells have spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The following tests and procedures may be used in the staging process:
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Gallium scan: A procedure to detect areas of the body where cells, such as cancer cells, are dividing rapidly. A very small amount of radioactive material, gallium, is injected into a vein and travels through the bloodstream. The gallium collects in the bones or other tissues (organs) and is detected by a scanner.
Bone marrow biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for signs of cancer.
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
The following stages are used for adult non-Hodgkin’s lymphoma:
Stage I
Stage I adult non-Hodgkin’s lymphoma is divided into stage I and stage IE (“E” stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes).
Stage II
Stage II adult non-Hodgkin’s lymphoma is divided into stage II and stage IIE (“E” stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes).
Stage II: Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE: Cancer is found in an organ or tissue other than the lymph nodes and may have spread to one or more lymph nodes on the same side of the diaphragm.
Stage III
Stage III adult non-Hodgkin’s lymphoma is divided into stage III, stage IIIE (“E” stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes), stage IIIS (“S” stands for spleen and means that the cancer is found in the spleen), and stage IIIS+E.
Stage III: Cancer is found in lymph node areas on both sides of the diaphragm.
Stage IIIE: Cancer is found in lymph node areas on both sides of the diaphragm and in one area of a nearby organ or tissue other than the lymph nodes.
Stage IIIS: Cancer is found in lymph node areas on both sides of the diaphragm and in the spleen.
Stage IIIS+E: Cancer is found in lymph node areas on both sides of the diaphragm, in one area of a nearby organ or tissue, and in the spleen.
Stage IV
In stage IV adult non-Hodgkin’s lymphoma, the cancer either:
is found throughout at least one organ or tissue other than the lymph nodes and may be in lymph nodes near this organ or tissue; or
has spread throughout one organ or tissue other than the lymph nodes and has spread to lymph nodes far away from that organ.
Adult non-Hodgkin’s lymphomas are also described in terms of how fast they grow and the location of affected lymph nodes.
Indolent or aggressive:
Indolent lymphomas: These tend to grow and spread slowly and have few symptoms. They are also called low-grade lymphomas.
Aggressive lymphomas: These grow and spread quickly and have severe symptoms. Lymphoblastic lymphoma, diffuse small noncleaved cell lymphoma and Burkitt lymphoma are 3 types of aggressive adult non-Hodgkin’s lymphoma. Aggressive lymphomas are seen more frequently in patients who are HIV-positive (AIDS-related lymphoma). Aggressive lymphomas are also called intermediate-grade and high-grade lymphomas.
Contiguous or noncontiguous:
Contiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are next to each other.
Noncontiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are not next to each other, but are on the same side of the diaphragm.
Recurrent Adult Non-Hodgkin’s Lymphoma
Recurrent adult non-Hodgkin’s lymphoma is cancer that has recurred (come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body. Indolent lymphoma may come back as aggressive lymphoma. Aggressive lymphoma may come back as indolent lymphoma.
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