Non-Hodgkin lymphoma stages

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on August 11, 2022.

The grade and stage of adult non-Hodgkin lymphoma (NHL) are important factors in evaluating treatment options. Staging helps to determine how far the disease has spread and whether it has invaded tissues and organs outside the lymph system. Grading non-Hodgkin lymphoma is important in helping to understand the growth pattern and aggressiveness of the cancer cells.

Grading non-Hodgkin lymphoma

Doctors will determine whether the lymphoma is low grade (indolent or slow growth rate), intermediate grade (moderate growth rate) or high grade (aggressive or rapid growth rate). While aggressive non-Hodgkin lymphoma often requires a more immediate and intensive treatment plan, many types of the disease typically respond well to treatment.

Staging non-Hodgkin lymphoma

Non-Hodgkin lymphoma staging is the process of identifying the location of the cancer, the number of lymph nodes affected by the cancer and whether the disease has spread from the original site to other parts of the body, including organs outside the lymphatic system, such as the liver or lungs. Doctors also look for affected lymph nodes near the diaphragm, the breathing muscle beneath the lungs. In earlier stages of non-Hodgkin lymphoma, affected lymph nodes are found only on one side of the diaphragm. In more advanced stages of non-Hodgkin lymphoma, the disease may be found on both sides of the diaphragm.

Additional staging factors for non-Hodgkin lymphoma

Presently, the Lugano classification is the staging system for non-Hodgkin lymphoma in adults; this system is derived from its predecessor, the Ann Arbor system. Stages of non-Hodgkin lymphoma are identified using the numbers 1 through 4. Your care team may also use the letters A, B, E and S to help describe the cancer.

A and B: The letter B indicates the presence of one or more of the following symptoms: drenching night sweats, fever or unexplained weight loss. The letter A is used if there is no evidence of B symptoms.

E and S: The letter E indicates the disease affects tissues or organs outside the lymphatic system. The letter S is used if the disease has spread to the spleen.

If the disease is considered “bulky” (greater than 10 cm in size), it is designated with an X.

Non-Hodgkin lymphoma stages

Stage 1 non-Hodgkin lymphoma: The cancer is found in a single region or organ, usually one lymph node and the surrounding area. For example, the cancer may be in one lymph node and the tonsils, or it may be found in only one area of an organ outside of the lymph nodes.

Stage 2 non-Hodgkin lymphoma: The cancer is found in two or more lymph node regions on the same side of the diaphragm. For example, the cancer may be located in at least two groups of lymph nodes, either above or below the diaphragm, such as nodes in the underarm and neck. Alternatively, it may be in a group of lymph nodes and in an organ close to the nodes and may affect groups of lymph nodes located either above or below the diaphragm.

Stage 3 non-Hodgkin lymphoma: The cancer is found in lymph nodes on both sides of the diaphragm, or it may be in the lymph nodes that are above the diaphragm and also in the spleen.

Stage 4 non-Hodgkin lymphoma: The cancer has spread to one or more tissues or organs outside the lymph system, such as the liver, lungs or bones, and may be found in lymph nodes near or far away from those organs.

Non-Hodgkin lymphoma survival rate

For people with non-Hodgkin lymphoma, the overall five-year relative survival rate is 73.8 percent, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program data. Researchers analyze the number of non-Hodgkin lymphoma patients in the past who are alive five years after their diagnosis to determine the survival rate.

It’s important to note that your personal survival rate may be different based on the type of lymphoma, its stage, your overall health and your response to treatment. It’s also important to keep in mind that your outlook may in fact be better than the survival rate indicates because newer treatments may improve your overall outcome.

Statistically, younger age groups have better outcomes than older age groups. According to SEER data, which classifies cancers into local, regional and distant stages, the five-year relative survival rates by age for non-Hodgkin lymphoma patients are as follows:

  • Younger than age 15: 91.3 percent
  • Ages 15 - 39: 85.9 percent
  • Ages 40 - 64: 80.8 percent
  • Ages 65 - 74: 74.2 percent
  • Age 75 and older: 57.2 percent

With certain types of lymphoma, it’s important to consider factors other than the cancer’s stage to determine prognosis. The International Prognostic Index (IPI) is often used to help doctors develop a patient’s treatment plan after calculating a prognostic score using these five factors:

  • Age
  • Stage of lymphoma
  • Location of lymphoma
  • Performance status (how well you’re able to function in day-to-day life)
  • Level of lactate dehydrogenase (LDH) in your blood (LDH levels increase as lymphoma spreads)

Good prognostic factors for most types of lymphoma include:

  • Being age 60 or younger
  • Having stage 1 or 2 lymphoma (which hasn’t spread outside of the lymph nodes or has spread only to one area)
  • Having a normal serum LDH

Poor prognostic factors include:

  • Being older than age 60
  • Having stage 3 or 4 lymphoma (which has spread to more than one organ outside of the lymph nodes)
  • Having a high serum LDH

Patients without any poor prognostic factors have an IPI score of 0, and those with all of the poor prognostic factors have a score of 5.

Next topic: What are the types of non-Hodgkin lymphoma?

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Show references
  • American Cancer Society (2018, August). Non-Hodgkin Lymphoma Stages.
  • Leukemia and Lymphoma Society. NHL Staging.
  • American Cancer Society (2021, January). Survival Rates and Factors That Affect Prognosis (Outlook) for Non-Hodgkin Lymphoma.