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December 22nd, 2010
08:33 AM ET

How many stages are there in non-Hodgkin's lymphoma?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the
American Cancer Society.

How many stages are there in non-Hodgkin's lymphoma?

Question asked by Paula Holman-Yorba, San Bernardino, California


In cancer medicine, staging is an assessment of spread of disease. Knowing the stage of the disease helps plan a treatment and determine the likely outcome and course course of disease.

Staging rules are determined by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). More detailed information can be found at the AJCC website.

Staging is based on knowledge of the way cancer develops. Some staging systems cover many types of cancer; others focus on a particular type. For most cancers, the stage is based on three main factors:

• What is the organ in which the original cancer started

• What is the size of the original tumor

• Has the cancer spread to surrounding lymph nodes

• Has the cancer spread to distant areas of the body

Information from the physical examination, medical imaging tests (such as X-rays, CT scans, and MRI scans) as well as laboratory tests are used to determine a "clinical stage." Surgical removal of the tumor allows for further assessment of the primary cancer and the areas of possible spread. This can result in a "pathologic stage." The pathologic stage, when available, is more accurate.

Given this information for most cancers, the physician will determine a TNM stage. The TNM staging system is based on the extent of the tumor (T1 to T4), the extent of spread to the lymph nodes (N0 to N3), and the presence of metastasis (M0 to M1). Once the T, N, and M are determined, they are combined, and an overall "stage" of I, II, III, IV is assigned. Sometimes these stages are subdivided as well, using letters such as IIIA and IIIB.

Leukemia, myeloma and brain tumors are usually staged differently.

Most cancers are staged from stage I which is localized or confined to the area where the malignancy started to stage IV, which means the cancer has spread far from its origin, usually to involve distant organs.

Stage helps determine the prognosis of the cancer. In general stage I has more successful outcomes than stage II, stage II is better prognosis than stage III, etc. In some diseases, there are subsets of stage indicated by a letter. stage IIB breast cancer is more advanced than stage IIA for example.

There are slight differences in the staging system for every type of cancer, so letters and numbers do not always mean the same thing for every kind of cancer. In some cancer types, additional factors are used to stage the disease.

In prostate cancer, the Gleason score (a microscopic grading of tumor aggressiveness) is used. In lymphoma (cancer of the lymphatic system), part of the staging includes whether or not some constitutional symptoms are present. These symptoms are fever, night sweats, or unexplained weight loss.

Stage also helps determine the most appropriate treatment for the cancer. Stage I and II cancers are most commonly treated with localized therapy such as surgery or radiation, but for certain cancers chemotherapy can be added. Stage III diseases are more commonly treated with radiation and chemotherapy, but in select patients with certain cancers can be treated with surgery.

Other elements determining appropriate treatment and prognosis include the kind of cancer and the overall health status of the patient. A stage III colon cancer in an otherwise healthy patient will most likely be treated with surgical removal of the effected part of the colon and a chemotherapy regimen specific to colon cancer given after the surgery. Someone with a stage III cancer of the throat may be reasonably treated with a chemotherapy regimen specific to head and neck cancer and radiation given during the course of the chemotherapy.

Next week:  The staging and treatment of lymphoma.

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soundoff (13 Responses)
  1. travis

    You never answered the question.

    December 22, 2010 at 10:49 | Report abuse | Reply
    • Bill

      The question was answered – there are four stages.
      However, the author could have been more clear and not mentioned how leukemia, myeloma, brain tumors and prostate cancer are staged differently. This made the article very confusing.

      December 22, 2010 at 20:04 | Report abuse |
    • All Access Landscape and Stamp concrete

      I know Huh? Duh I had this cancer I really was looking forward to the answer my self...

      December 23, 2010 at 10:29 | Report abuse |
    • All Access Landscape and Stamp concrete

      @ bill Ok he did ..Lol...I read it a second time . But I think It should of started off ..There are 4 stages to this cancer... Just like doctors tho they run all around the world to answer the ? . But I must say I love my doctors @ Kaiser of Vallejo Ca and Stanford

      December 23, 2010 at 10:33 | Report abuse |
  2. ME

    NHL falls under the "most cancers" category Travis the Troll:

    "Most cancers are staged from stage I which is localized or confined to the area where the malignancy started to stage IV, which means the cancer has spread far from its origin, usually to involve distant organs."

    December 22, 2010 at 12:47 | Report abuse | Reply
  3. cj

    Typical answer to a specific cancer question. Travis asked about lymphoma and got a very general answer that did not answer his question. NCI's Physician Data Query (PDQ) found at gives specific staging and treatment info in 2 formats patient and physician. Oh and BTW lymphoma staging should have been included with leukemia (blood cell tumors) and brain tumors not other (solid tumors).

    December 22, 2010 at 19:47 | Report abuse | Reply
  4. Pumbaa

    No one knows how long he or she will live. However with a stage IV cancer diagnosis it is not a good idea to count on collecting the interest on a long-term bond.

    December 22, 2010 at 19:56 | Report abuse | Reply
    • JustSayin

      You are absolutely correct for many patients. However, there are so many people who fight back and win. My dad was diagnosed with Stage IV Non-Hodgkins Lymphoma in 2004. He told us right from the beginning that it just wasn't his time. We just had a party celebrating the 5 year anniversary of his stem-cell transplant. He's alive and doing wonderfully. The doctor had told us that Stage IV was when it Metastasized into other organs and was no longer confined to one specific organ. In his case it had spread into the lymph nodes in his abdomen.

      December 23, 2010 at 09:09 | Report abuse |
    • All Access Landscape and Stamp concrete

      @ Just sayin... Big ups on your dad 5 year anniversary. I to had stem cell transplant in 07. But whats funny I dont know if I was stage % . I was just like hurry up . I for sure was not leaving this earth @ 34 I have 2 little boys...http://www.facebook.com/allaccesslandscapeconstruction

      December 23, 2010 at 10:43 | Report abuse |
  5. cj

    Well that is strange I included the PDQ website and it was edited out. I do not know why it is so difficult to find usefull cancer info. General info is easy to find but after a diagnosis of cancer not very usefull. The PDQ's are specific and current but take a little work to find. Good medical info should not be so hard to find we are talking about life and death here.

    December 22, 2010 at 20:12 | Report abuse | Reply
  6. cj

    Pumbaa makes a good point if you have a solid tumor since stage IV for most of these tumors is considered incurable. But Stage IV large cell (agressive) B-cell lymphoma has an 80% cure rate. On the other hand a benign (not cancer) brain tumor can be deadly even with treatment. Again I wonder why the PDQ's which are specific to each disease are not included in general cancer info.

    December 22, 2010 at 20:20 | Report abuse | Reply
  7. doree

    My husband is stage IV non-hodgkins marginal zone lymphoma. His cavity is full and is in the bone marrow. It is also in the spinal fluid. What is the best treatment for him. He has had 6 intravenous treatments of methotrexate and 6 intratheical injections of methotrexate. It has plateau, they are now starting a new regimen. I would like to know ur opinion on what he should be getting, so I can compare it to what they are going to give him.

    Thank you, look toward to hearing your reply.

    February 4, 2011 at 09:46 | Report abuse | Reply
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