Hodgkin lymphoma staging

Staging describes how much of the body is affected by the Hodgkin lymphoma. Knowing your stage helps your healthcare team plan the right treatment for you.

Staging can be complicated. We explain on this page how staging is worked out, and what the different numbers and letters mean. Your doctor or nurse will explain what stage Hodgkin lymphoma you have, and what this means for you.

Doctors work out what stage Hodgkin lymphoma you have by looking at:

• how many places in your body are affected
• what symptoms you have
• how large any swollen lymph nodes are.

Hodgkin lymphoma is staged using a system of numbers from 1-4 and letters. Your doctor might also say you have early-stage or advanced-stage Hodgkin lymphoma. We explain what all these things mean below.

The most common test used to work out your stage is a PET-CT scan.

The main stages of Hodgkin lymphoma are:

• Stage 1: Only one lymph node or group of lymph nodes is affected, in one place in your body.
• Stage 2: More than one group of nodes is affected but all of them are on the same side of the diaphragm, either above or below. The diaphragm is a sheet of muscle separating your chest from your stomach and hip areas (abdomen and pelvis).
• Stage 3: Lymph nodes on both sides of the diaphragm are affected.
• Stage 4: The lymphoma has spread to other organs, such as the lungs, liver or bone marrow.

Sometimes you might see these written down as Roman numerals I, II, III and IV.

Your doctor may also add a letter or letters to the number stage:

• B – if your doctor writes B next to your number stage, it means you have one or more “B symptoms.” B symptoms are fever, unexplained weight loss and night sweats.
• A – if you don’t have any of the B symptoms above, your doctor will put the letter ‘A’ next to your stage.
• E – If your doctor writes the letter ‘E’ next to your stage, it means the lymphoma has extended out from the lymph node into another organ close to the affected node.
• X – your doctor may add the letter X after your stage if you have “bulky” disease. This means you have a lymph node that measures 10cm or more, or you have lymphoma in your chest that is at least a third of the width of your chest.
• S – the lymphoma has spread to the spleen.

Your hospital team might also say you have early stage or advanced stage Hodgkin lymphoma. Early stage is stages 1 and 2, and advanced stage is stages 3 and 4.

If you have early-stage Hodgkin lymphoma, your doctor might describe it as favourable or unfavourable. Whether you have favourable or unfavourable Hodgkin lymphoma depends on a number of things, including the number of lymph nodes affected and whether or not you have B symptoms. We explain more about this on our page about Hodgkin lymphoma prognosis.

It can be very worrying to hear you have unfavourable or advanced stage Hodgkin lymphoma. It’s important to know that while you might need more treatment, there’s still a high chance the treatment will be successful and the Hodgkin lymphoma will be cured.