Stages of non-Hodgkin lymphoma

The stages of non-Hodgkin lymphoma (NHL) tell you about the number and places in the body that are affected by lymphoma.

Knowing the stage helps your doctor to decide what treatment you need. Your doctor will also ask you about your symptoms.

The Lugano classification is used to stage lymphoma. There are 4 stages. Or these can be simplified into limited (early) or advanced stage. 

Other staging systems

There are different staging systems for skin lymphoma and childhood NHL. If your child has NHL, ask your specialist to explain their stage.

How doctors work out your stage

Doctors look at whether the lymphoma is:

• on one side, or both sides of your diaphragm
• inside or outside the lymphatic system
• the size of the lymphoma

They do this by carrying out various tests, such as a CT or PET-CT scan .

The diaphragm

The diaphragm (pronounced dia-fram) is the big breathing muscle that separates the chest from the tummy (abdominal) area. 

Doctors use the diaphragm as a guide because it is about halfway down the body.

Inside or outside of the lymphatic system

Doctors look at whether the lymphoma is affecting:

• the nodes and organs of the lymphatic system – these are called lymphatic sites

• areas outside of the lymphatic sites – these are called extranodal (or extralymphatic) sites

Lymphatic sites include a group of lymph nodes or an organ of the lymphatic system, such as the thymus or spleen .

Extranodal sites include the lungs, liver, blood, bone marrow, kidneys, brain and spinal cord. 

Your doctor may use the letter E after the stage number if you have lymphoma outside of the lymphatic system. Your doctor or nurse can explain what this means in your situation.

Bulky disease

This means that you have areas of lymphoma that measure above a certain size. The exact measurement depends on your type of NHL.

For example, in follicular lymphoma, bulky disease measures over 6 cm. In diffuse large B cell lymphoma, bulky disease is usually greater than 10 cm.

Stage 1

This means that you have one of the following:

• lymphoma in a single lymph node or one group of lymph nodes, or an organ of the lymphatic system (such as the thymus)

• lymphoma in an extranodal site (this is called stage 1E)

Below is an example of stage 1 lymphoma. 

Stage 2

This means one of the following:

• your lymphoma is in two or more groups of lymph nodes

• your lymphoma is in an extranodal site and one or more groups of lymph nodes (this is called stage 2E)

In both cases, the 2 sites of lymphoma are on the same side of the diaphragm.

Below is an example of stage 2.

Stage 3

This means that you have lymphoma on both sides of the diaphragm.

One example is that the lymphoma is in lymph nodes on both sides of the diaphragm. Another example (see below) is that the lymphoma is in lymph nodes above the diaphragm, as well as lymphoma in the spleen.

Stage 4

Stage 4 means one of the following:

• your lymphoma is in the lymph nodes and has spread to at least one organ outside of the lymphatic system, such as the bone marrow or liver

• your lymphoma is in more than one extranodal site, for example the liver, bones or lungs

Below is an example of stage 4 lymphoma.

These stages made simple

Your doctor may describe your lymphoma as being:

• limited or early stage
• advanced stage

Limited stage

Limited disease generally means you have stage 1 or stage 2 NHL. Doctors also call this early stage NHL.

Advanced stage

Advanced disease means you have stage 3 or stage 4 NHL.

Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.

You doctor or specialist nurse can explain what stage you have and what this means in your situation.

Treatment

The stage of your lymphoma helps your doctor to decide which treatment you need. Your treatment also depends on:

• the type of lymphoma you have

• whether your lymphoma is slow growing (low grade) or fast growing (high grade)

• where the lymphoma is in your body (the stage)

• your symptoms

• other health conditions that you have

• your age

The main types of treatment for NHL are:

• chemotherapy
• radiotherapy
• targeted and immunotherapy drugs

Other treatments include:

• stem cell transplant
• surgery

You may have just one type of treatment or a combination of treatments. 

Some people with NHL might not need treatment straight away. They have regular check ups instead. This is called watch and wait or active monitoring.

We have information about treatment for some of the different types of NHL.