Cancer Treatment Centers of America

Hodgkin lymphoma stages

Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of Hodgkin lymphoma is an important factor in evaluating treatment options.

Our cancer doctors use a variety of diagnostic tests to evaluate Hodgkin lymphoma and develop an individualized treatment plan.

The Cotswold system (formerly the Ann Arbor Staging System) characterizes the stages of Hodgkin lymphoma by the number and location of affected lymph nodes. Early cancer stages (stages I or II) are described by the number of lymph nodes the cancer has affected. The most advanced stage (stage IV) is characterized by the spread of cancer to other parts of the body.

Additional staging factors

Additional letters, A, B, E and S are often used to further describe Hodgkin lymphoma. The letters A and B indicate the presence or absence of certain symptoms. The letters E and S refer to the spread of the cancer beyond the lymph nodes:

  • A & B: The letter “B” is used if any of the following symptoms are present: unexplained weight loss, drenching night sweats, or fever. The letter “A” is used if there is no evidence of B symptoms. If the disease is considered “bulky” (with large tumors, greater than 10 cm in size, spanning the chest region), it is designated with an “X.”
  • E & S: Extranodal cancers that have spread beyond the lymph nodes into other tissues or organs are indicated by the letter “E.” An extranodal cancer that has spread to the spleen is indicated by the letter “S.” Approximately 30 percent of people with Hodgkin lymphoma will develop an enlarged spleen (splenomegaly).

Your doctor will also determine whether the lymphoma is low grade (indolent or slow growing), intermediate grade (moderate growth rate), or high grade (aggressive or rapid growth).


Last Revised: 02/24/2017

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