After diagnosing your lymphoma, your doctor needs to see how far the disease has spread, which is called its stage. Lymphoma may be in just 1 area, but it tends to be more widespread. That's because it can easily move through the lymphatic system. Your treatment plan and prognosis depend on the type of lymphoma you have and its stage. But the chances of curing lymphoma have more to do with the type than the stage.
Lymphomas can spread to lymph nodes in more than 1 area of the body. They may also spread to the bone marrow and to other organs in the body. Lymphomas tend to spread in different ways, depending on where they began. Aggressive, fast-moving lymphomas tend to spread to other lymph nodes first. They usually don't involve bone marrow until later. Slow-growing lymphomas often involve the bone marrow and may be widespread at the time of diagnosis. Slow-growing lymphomas are also called indolent lymphomas.
Lymphoma that begins in an organ that is not a lymph node, such as the stomach, is called extranodal lymphoma. This lymphoma tends to spread first to the lymph nodes near that organ or to sites other than the lymph nodes.
The staging system used most often to describe the spread of non-Hodgkin lymphoma is called the Ann Arbor Staging System. It uses Roman numerals (I to IV) for different stages. A lymphoma that affects organs or tissues other than the lymph nodes has an E added to its stage. If it affects the spleen, an S is added. If the patient has fever, night sweats, or unexplained weight loss, the letter B is added; if none of these is present, an A is added.
Stage I. The lymphoma is in 1 group of the body's lymph nodes, such as the groin or neck, or is in 1 organ outside of the lymph system.
Stage II. Two groups of lymph nodes (or 1 organ and a group of nearby lymph nodes) on the same side of the diaphragm contain lymphoma. The diaphragm is the muscle that divides the chest and the abdomen. For example, lymphoma might be above the diaphragm in lymph nodes in the neck and underarms. Or lymphoma might be below the diaphragm in lymph nodes in the groin and abdomen.
Stage III. The lymphoma is in lymph nodes on both sides of the diaphragm. It may have also spread into a nearby organ and/or into the spleen.
Stage IV. The lymphoma is in stage IV if any of these are true:
The lymphoma is present in the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs).
The lymphoma has spread throughout 1 organ or tissue other than the lymph nodes
The lymphoma is in an organ outside of the lymphatic system and has spread to lymph nodes or other organs far away from that organ.