Lymphoma & related disorders
General
Staging


Topic Completed: 1 February 2011

Minor changes: 7 July 2020

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PubMed Search: staging hodgkin AND non-hodgkin lymphoma

Nikhil Sangle, M.D.
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Cite this page: Sangle N. Staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphomastaging.html. Accessed September 24th, 2020.
Definition / general
  • Typically done by Oncology, not Pathology, for lymphoma
St. Jude staging system (pediatric)
Stage I:
  • A single tumor (extranodal) or single anatomic area (nodal), with the exclusion of mediastinum or abdomen

Stage II:
  • A single tumor (extranodal) with regional node involvement
  • Two or more nodal areas on the same side of the diaphragm
  • Two single (extranodal) tumors with or without regional node involvement on the same side of the diaphragm
  • A primary gastrointestinal tumor, usually in the ileocecal area, with or without involvement of associated mesenteric nodes only

Stage III:
  • Two single tumors (extranodal) on opposite sides of the diaphragm
  • Two or more nodal areas above and below the diaphragm
  • All primary intrathoracic tumors (mediastinal, pleural, thymic)
  • All extensive primary intra-abdominal disease
  • All paraspinal or epidural tumors, regardless of other tumor site(s)

Stage IV:
  • Any of the above with initial CNS or bone marrow involvement

Notes:
  • Stage III intra-abdominal disease typically exhibits spread to paraaortic and retroperitoneal areas by implants and plaques in mesentery or peritoneum, or by direct infiltration of structures adjacent to the primary tumor; ascites may be present, and complete resection of all gross tumor is not possible
  • Stage II GI tract lymphoma typically is limited to one segment of the gut plus or minus the associated mesenteric nodes only and the primary tumor can be completely removed grossly by segmental excision
  • If marrow involvement is present initially, the number of abnormal cells must be 25% or less in an otherwise normal marrow aspirate with a normal peripheral blood picture
  • References: J Clin Oncol 1989;7:186
Ann Arbor staging system
  • I: Involvement of a single lymphatic site (i.e., nodal region, Waldeyer ring, thymus or spleen)
  • IE: Localized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement
  • II: Involvement of two or more lymph node regions on the same side of the diaphragm
  • IIE: Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement with or without involvement of other lymph node regions on the same side of the diaphragm; number of regions involved may be indicated by a subscript, as in II3
  • III: Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE, S); splenic involvement is designated by the letter S
  • IV: Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph node involvement; or isolated extralymphatic organ involvement in the absence of adjacent regional lymph node involvement, but in conjunction with disease in distant site(s); stage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid
National Cancer Institute Modified Staging for Intermediate and High Grade Lymphomas
  • I: Localized disease (nodal or extranodal)
  • II: Two or more nodal sites or a localized extranodal site plus draining sites plus either performance status ≤ 70, B symptoms, any mass > 10 cm, serum LDH > 500, 3 or more extranodal sites of disease
  • III: Stage II and any poor prognostic factor
  • Edge: AJCC Cancer Staging Manual, 7th ed, 2011
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