Stages of Lymphoma and What They Mean

Cancer treatments and prognoses, or likely outcomes, depend in part on the stage of your disease. Generally, staging is a system of categorizing an individual's disease into groups, or stages, which depend on how far the disease has spread and how much of the cancerous disease is already established in the body at the time of diagnosis and treatment planning.

According to the American Cancer Society, healthcare providers may choose from a number of different methods to take a sample of the involved tissue, or a biopsy, for testing and microscopic analysis. These methods include different techniques for sampling the lymph nodes, bone marrow, or involved organs.

In general, the results of imaging tests such as PET/CT scans are the most important when determining the stage of the lymphoma. When PET/CT is available, it is used for staging. PET/CT scans combine CT and PET, or positron emission tomography, to find out how far the cancer has spread and how big it has become.

Doctor evaluating patient's MRI for lymphoma
Eric Audras / ONOKY / Getty Images

How Lymphoma Staging Is Used

The stage of a lymphoma can help determine a person’s treatment options, but staging is more important for some types of lymphoma than for others.

For example, for many of the common types of non-Hodgkin lymphoma (NHL), stage I or stage II non-bulky disease is considered limited while stage III or IV is considered advanced, and treatment is recommended accordingly; and, for stage II bulky lymphomas, prognostic factors are used to help determine if the lymphoma should be treated as limited or advanced.

For some other types of NHL, the fast-growing lymphoma known as Burkitt lymphoma, for instance, the stage is not as important in deciding the treatment.

4 Major Stages of Lymphoma

The current staging system for NHL in adults is the Lugano classification, which is based on the older Ann Arbor system. There are four major stages, along with descriptors and modifiers.

Stage I

The disease is present in only one group of lymph nodes, or, more rarely, in a single organ that does not belong to the lymph system.

Stage II

Cancer is found in two or more groups of lymph nodes on the same side of the body with respect to the diaphragm. (The diaphragm is a thin muscle below the lungs that helps in breathing and separates your chest from the abdomen). In addition, an organ not in the lymph system may be involved close to the involved nodes.

Stage III

The disease is present in lymph node groups on both sides of the diaphragm, occasionally with the involvement of other adjacent organs. If the spleen is involved then the disease becomes stage III as well.

Stage IV

If the liver, the bone marrow, or the lungs become involved, the disease is in stage IV. The same is true if other organs are involved far away from involved nodes.

What Letters Mean in Lymphoma Staging

You will often find some additional letters used with the stage to describe the lymphoma.

A and B

The most important ones are A and B. Often, patients may have fever, weight loss, or excessive night sweats as symptoms.

If any of these symptoms (called 'B' symptoms) are present, a 'B' is added to their stage description. If none of these symptoms exist, an 'A' is added. Those with B-symptoms may, in some cases, have worse results than those who don't; however, the presence of B symptoms may have increased or decreased clinical significance, depending on the lymphoma type.

E and S

If any organ that does not belong to the lymph system is involved, it is denoted with an 'E' after the stage. 'E' denotes extra-lymphatic organ involvement. If the spleen is involved, the corresponding letter is 'S.'

A Word From Verywell

Advanced-stage disease does not always result in a poor outcome. The disease stage is an important parameter for success or failure, but many patients with advanced stage lymphoma are cured. A number of sub-types of lymphoma have good results with treatment even in advanced stage disease.

Often, other factors like your age or the size of your disease are equally important for prognosis. Your healthcare provider is the person best suited to guide you regarding your chances of treatment success or failure.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Indranil Mallick, MD
 Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma.