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Cancer Treatment Centers of America

Staging and grading non-Hodgkin lymphoma

The grade and stage of adult non-Hodgkin lymphoma 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

Stages of non-Hodgkin lymphoma are identified using the Roman numerals I through IV. Doctors may also use the letters A, B, E and S to help describe the cancer. The letters A and B indicate the presence or absence of certain symptoms. The letters E and S refer to the spread of the disease beyond the lymph nodes.

  • A & 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 & 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.


Last Revised: 05/09/2018

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