Hodgkin lymphoma (HL) can occur in different locations within the body. It often develops within lymph nodes — small glands that filter out foreign substances like germs. As the lymphoma becomes more advanced, it may spread to other organs or to other sets of lymph nodes. Doctors describe how far the lymphoma cells have spread by assigning a stage. The stage is used to recommend treatments and estimate outlook.
Doctors use a variety of tests when determining a person’s lymphoma stage. Among the most important are imaging tests, such as positron emission tomography (PET) scans and computed tomography (CT) scans. These tests can help doctors find cancer cells located in other parts of the body and identify enlarged lymph nodes, allowing them to see where lymphoma has spread.
Doctors use staging systems to assign lymphoma stages. Originally, doctors used the Ann Arbor staging system, developed in 1971. Now, many doctors have switched to the Lugano classification system, which was adapted from the Ann Arbor system. Lugano classification is also used to stage non-Hodgkin lymphoma.
There are four Hodgkin lymphoma stages. The stage describes which parts of the lymphatic system are affected. The lymphatic system is a part of the immune system and includes lymph nodes, lymph vessels, and several different organs. The system helps the body fight infection and get rid of waste. The higher a lymphoma’s stage, the further the disease has spread to different parts of the lymphatic system or to other tissues outside the system.
Stage 1 lymphoma (also written as stage I) is diagnosed when cancer cells are only found in one area of the body. Lymphoma cells may be found in:
People with stage 2 (stage II) HL have lymphoma cells in multiple nearby locations. In many cases, people with stage 2 disease have cancer in two or more groups of lymph nodes on the same side of the body. The body is divided by a thin muscle called the diaphragm that sits underneath the lungs. Stage 2 Hodgkin lymphoma may affect multiple lymph node regions on the top half of the body, such as in the chest or neck. Alternatively, people are diagnosed with stage 2 disease if they have cancer in multiple groups of lymph nodes in the lower part of the abdomen.
Doctors will also diagnose stage 2 HL if they find lymphoma cells in a group of lymph nodes and in a nearby organ. Both the nodes and the organ are on the same side of the diaphragm.
In stage 3 (stage III) Hodgkin lymphoma, cancer cells have spread further within the body. They are found in multiple lymph node areas on both sides of the diaphragm. A person may also be diagnosed with stage 3 disease if they have cancer in lymph nodes above the diaphragm and in the spleen.
Stage 4 (stage IV) Hodgkin lymphoma has spread outside of the lymphatic system. People who have stage 4 lymphoma have cancer cells found throughout one or more organs like the bone marrow, lungs, or liver.
Sometimes, doctors may add a letter to the end of the disease stage (e.g., stage 2E). Each of these letters has a different meaning that further describes the instance of cancer:
Doctors use a person’s lymphoma stage as one factor in making treatment decisions. Doctors will also consider the type of lymphoma a person has, as well as their age, general health, personal preferences, and signs and symptoms.
Doctors consider stage 1 and stage 2 HL to be early-stage disease. Different treatment decisions may be made depending on whether the lymphoma is “favorable” or “unfavorable.” Favorable Hodgkin lymphoma is unlikely to relapse (come back after being treated). Unfavorable lymphoma, on the other hand, has a higher chance of relapsing.
Doctors use several factors to determine whether or not an instance of lymphoma is favorable. Factors that increase the chances lymphoma will return include:
Early-stage, favorable Hodgkin lymphoma can be managed with less aggressive treatments. People in this group typically undergo chemotherapy, radiation therapy, or both. Those who have early-stage, unfavorable HL often receive more intense treatments, such as stronger chemotherapy drugs or additional rounds of chemotherapy. People also often receive radiation treatments.
If a person’s lymphoma is resistant to treatment, they may choose other options, such as stronger chemotherapy drugs, immunotherapy, or a stem cell transplant.
Doctors use a different set of risk factors to determine the likelihood that stage 3 or stage 4 Hodgkin lymphoma will return. These factors include:
Doctors typically recommend a more aggressive treatment plan for stage 3 and stage 4 Hodgkin lymphoma. Most people with advanced-stage Hodgkin lymphoma receive several rounds of intense chemotherapy. Radiation therapy is often used to treat larger tumors. As is the case with early-stage tumors, lymphoma that is resistant to therapy may be treated with immunotherapy drugs or with a stem cell transplant.
In general, people with early-stage disease have a better prognosis (outlook) than those with advanced lymphoma. However, even stage 4 Hodgkin lymphoma can be cured — treatments may help the lymphoma go away and not come back.
The prognosis for people with Hodgkin lymphoma is measured using a five year relative survival rate. This number is a comparison between people with and without a particular cancer. The overall five year relative survival for everyone with HL is 88.3 percent. This means that those with Hodgkin lymphoma are about 88.3 percent as likely to live for five years or more after diagnosis compared to people without Hodgkin lymphoma. This survival rate changes by stage:
These numbers were calculated using information from people who were diagnosed between 2011 and 2017. Survival rates are constantly improving, so people diagnosed with Hodgkin lymphoma today may have an even better outlook.
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