The Stages of Non-Hodgkin Lymphoma

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The stage of cancer is the term doctors use to describe where your cancer is located in your body and where it may have spread. Cancer is harder to treat and cure when it's in more than one place in the body. Cancer staging helps doctors decide on the type of treatment. It also predicts how successful treatment might be. Your chance for successful treatment is your prognosis.

To learn the stage of non-Hodgkin lymphoma, your doctors may:

  • Do a physical exam

  • Take biopsies

  • Do blood tests

  • Do imaging studies

  • Take samples of your bone marrow or spinal fluid

Non-Hodgkin lymphoma is a cancer that usually starts in the lymph nodes. These are grouped in areas close together, called regions. Non-Hodgkin lymphoma can spread to other areas of your lymphatic system, including your bone marrow or spleen. It can also spread to organs outside your lymph system, such as your liver, lungs or brain.

Stages for Non-Hodgkin Lymphoma

Doctors use numbers to name the stages. Stage 1 cancers are easiest to treat and have the best prognosis. Stage 4 cancers are hardest to treat and have the worst prognosis. These are the stages for non-Hodgkin lymphoma:

  • Stage 1: Cancer is in just one lymph node region, one lymphatic system organ, or one organ outside the lymphatic system.

  • Stage 2: Cancer is in two or more lymph node regions on the same side of your diaphragm. That's the muscle that separates your chest from your belly. Stage 2 may also be cancer in one lymph node region and one nearby organ. This may include other lymph node regions on the same side of the diaphragm.

  • Stage 3 and stage 4: Cancer is in lymph node regions on both sides of your diaphragm, or the cancer has spread widely to one or more organs outside the lymphatic system. This could be your bone, liver or lung. Stages 3 and 4 are usually grouped together because the treatment and prognosis are similar.

How the Stage of Non-Hodgkin Lymphoma Affects Treatment

The stage of your cancer plays an important role in treatment decisions. The type of cancer is also important. Some non-Hodgkin lymphomas grow and spread more quickly than others. Those are aggressive cancers. Some grow and spread more slowly. Those are indolent cancers.

Your doctors will tailor your treatment to fit the specific type of non-Hodgkin lymphoma and its stage, as well as your personal preferences. Lymphoma specialists consider the following treatments:

  • For stage 1 and 2 indolent cancers: Treatment options include radiation therapy and chemotherapy. Another option for slow-growing lymphomas may be what doctors call "watchful waiting." That may be an option if you have cancer but no symptoms. Your doctor will monitor your cancer closely. But, you won't start treatment unless your condition changes. Another option is monoclonal antibody therapy. This targeted cancer treatment uses special substances (antibodies) made in a laboratory. They attach to cancer cells and kill the cells. Or, they make it easier for other treatments to find and kill the cancer cells.

  • For stage 3 and 4 indolent cancers: Treatment options include all the treatments for stage 1 and 2. Additional treatments include combinations of chemotherapy and targeted therapy, specifically a drug (kinase inhibitor) that blocks a protein cancer cells need to grow and survive.

  • For all stages of aggressive cancers: Treatment options include monoclonal antibody therapy, combination chemotherapy, and radiation. Your doctor can prescribe additional medicines to treat side effects of cancer treatment. Palliative care to ease cancer symptoms will also be part of any cancer treatment plan.

There may be additional treatment options not described here, including drugs in clinical trials. There also are treatments for cancers that come back and for cancers that don't respond to other treatments. Talk with your doctor about the stage of your cancer and what the best treatment options are for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Aug 3
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

  1. Non-Hodgkin Lymphoma Stages. American Cancer Society. https://www.cancer.org/cancer/non-hodgkin-lymphoma/detection-diagnosis-staging/staging.html

  2. Lymphoma – Non-Hodgkin: Stages. American Society of Clinical Oncology. http://www.cancer.net/cancer-types/lymphoma-non-hodgkin/stages

  3. Treatment Options for Indolent Non-Hodgkin Lymphoma. National Cancer Institute. https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_419

  4. Treatment Options for Aggressive Non-Hodgkin Lymphoma. National Cancer Institute. https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_428

  5. Treatment Option Overview. National Cancer Institute. https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_190