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Hodgkin lymphoma stages

This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 26, 2022.

Hodgkin lymphoma is diagnosed by stages and categories. There are four stages of Hodgkin lymphoma—1, 2, 3 and 4—each determined by how much the disease has spread from a single lymph node region to the rest of the body. The categories—A, B, E, S and X—measure the presence of certain symptoms and to where in the body the disease may have spread.

Accurately diagnosing the stage and category of Hodgkin lymphoma is an important factor in evaluating treatment options. Our doctors use a variety of diagnostic tests to evaluate Hodgkin lymphoma and develop an individualized treatment plan tailored to each patient’s needs.

What is stage 1 Hodgkin lymphoma?

With stage 1 Hodgkin lymphoma, the following is true:

  • The cancer affects one lymph node region or lymphoid organ.
  • When Hodgkin lymphoma affects an organ of the body outside of the lymphoid system, it is considered stage 1E, also called extranodal lymphoma.
  • Treatment is usually two to four rounds of chemotherapy. You may also undergo radiation therapy.

What is stage 2 Hodgkin lymphoma?

With stage 2 Hodgkin lymphoma, the following is true:

  • The cancer affects two or more lymph node areas on the same side of the body. The cancer may be located above or below the diaphragm, which is a thin area of muscle that separates your chest from the abdomen.
  • The cancer affects one organ and a nearby lymph node area. This is considered stage 2E Hodgkin lymphoma.
  • Two to four rounds of chemotherapy and possibly radiation are used to treat stage 2 Hodgkin lymphoma.

What is stage 3 Hodgkin lymphoma?

  • With stage 3 Hodgkin lymphoma, cancer is on both sides of the diaphragm. It’s also possible that the cancer is in the lymph nodes above the diaphragm as well as in the spleen.
  • Six to eight rounds of chemotherapy are often used as treatment for this stage of Hodgkin lymphoma. Steroids and radiation therapy may also be recommended.

What is stage 4 Hodgkin lymphoma?

This is the most advanced stage for this type of cancer. In stage 4 Hodgkin lymphoma, the following is true:

  • The cancer has spread to at least one organ outside of the lymphatic system, such as the liver, lungs or bone marrow. This is in addition to cancer in the lymph nodes.
  • Treatment for stage 4 Hodgkin lymphoma typically includes six to eight rounds of chemotherapy, and possibly steroids and radiation therapy.

Staging categories

In addition to stages, these letters are used to indicate the presence or absence of certain symptoms and/or how far the cancer has spread beyond the lymph nodes:

A indicates no symptoms have developed.

B is used when any of the following symptoms have developed: unexplained weight loss, drenching night sweats or fever.

X is used when the disease is considered “bulky,” with large tumors, greater than 10 cm in size, spanning the chest region.

E indicates extranodal cancers that have spread beyond the lymph nodes into other tissues or organs.

S is used when the cancer has spread to the spleen. Approximately 30 percent of Hodgkin lymphoma patients will develop an enlarged spleen (splenomegaly).

Next topic: How is Hodgkin lymphoma diagnosed?

Hodgkin lymphoma survival rates

Hodgkin lymphoma survival rates have increased in recent years, thanks to more advanced treatments. According to the American Cancer Society, the five-year relative survival rates are:

  • For all patients with Hodgkin lymphoma: 88 percent
  • For localized Hodgkin lymphoma: 92 percent
  • For more advanced Hodgkin lymphoma that has reached distant organs such as the lungs or bone marrow: 82 percent

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