Non Hodgkins Lymphoma Staging
Once the Non Hodgkins Lymphoma Diagnosis is made, the physician needs to stage the disease. This determines the
treatment options and the survival estimation.
The most popular classification system for staging Non Hodgkins Lymphoma is the Ann Arbor staging system. It depends on
many factors including:
Stage I is characterized by the presence of one affected lymph node on one side of the diaphragm.
- The number of the affected lymph nodes
- The extent of the disease transmission to other organs
- The location of the diseased nodes, with respect to the diaphragm (The muscle that separates the chest from the
- The presence or absence of symptoms.
Stage II is characterized by the presence of two affected lymph nodes on one side of the diaphragm.
Stage III is characterized by the presence of three affected regions on both sides of the diaphragm.
Stage IV is characterized by the presence of a disease that has disseminated to organs different from the lymphatic
system like the bone marrow, the skin, or the cerebrospinal fluid.
In general, the presence of symptoms is denoted as B next to the nomination of each stage above and the absence of
symptoms is denoted by A. So stage II A would mean the affected person is asymptomatic and has two affected lymph nodes
on one side of the diaphragm.
In the process of staging clarification, the International Prognostic Index (IPI) is usually used. It assesses the
nature of the disease and predicts the risk of relapse, survival, and the rate of the response to the treatment taking
into consideration several factors including age, stage of the disease, the general health status of the patient, the
number of affected sites which are outside the lymphatic system, and the level of Lactate DeHydrogenase (LDH), an
enzyme used in many reactions occurring in our body. For instance an IPI of 0 to 1 reflects a low risk status, IPI of 2
describes a low intermediate risk, IPI of 3 is generally a high intermediate risk and an IPI equal or superior to 4 is
a reflection of a high risk patient.
In children, the most commonly used system for staging Non Hodgkin's lymphoma is the St Jude Children's Research
Hospital Model. It classifies the disease as limited or extensive ranging from stage I to stage IV.