Cancer Treatment Centers of America

Staging and grading non-Hodgkin lymphoma

Making an educated treatment decision begins with the stage, or progression, of the disease. The grade and stage of non-Hodgkin lymphoma are important factors in evaluating treatment options.

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

Grading NHL

Grading NHL is important because it helps us understand the growth pattern and aggressiveness of the cancer cells. We 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). It’s important to keep in mind that while aggressive NHL often requires more immediate and intensive treatment, the disease tends to respond well to treatment.

Staging NHL

NHL staging is the process of identifying the location of the tumor, the size of the tumor and whether the disease has spread from the original site to other parts of the body. The Cotswold system (formerly the Ann Arbor Staging System) characterizes the stages of non-Hodgkin lymphoma by the number of lymph nodes involved and the regions affected by the cancer.

In earlier stages of NHL, the lymph nodes affected are all on one side of the diaphragm (the breathing muscle beneath the lungs). In contiguous lymphoma, the cancerous lymph nodes are next to each other. In non-contiguous lymphomas, the cancerous lymph nodes are not next to each other, but are on the same side of the diaphragm. In more advanced stages of non-Hodgkin lymphoma, the disease may be on both sides of the diaphragm.

Additional staging factors for NHL

In addition to the numerical NHL staging component, we 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 extranodal tissues or organs (areas outside of the lymph 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.”

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