The Stages of Non-Hodgkin Lymphoma: How Your Stage Affects Your Outlook

"While [staging is] important, it doesn’t necessarily have the same level of importance as certain solid tumors, because of the propensity of lymphocytes to circulate," Dr. Lawrence Piro, medical oncologist with The Angeles Clinic & Research Institute in Los Angeles, tells SurvivorNet.

And although people are often diagnosed with lymphoma at a late stage, "The stages are often equally treatable," he adds.

Counting the Stages

Non-Hodgkin lymphoma has four stages:

• Stage I means the cancer is only in one area of lymph nodes.
• Stage II is when the cancer is in two or more groups of lymph nodes, but the nodes are on the same side (either above or below) the diaphragm the thin layer of muscle that separates the chest from the abdomen.
• Stage III is when the cancer is in lymph nodes both above and below the diaphragm, or is only in lymph nodes above the diaphragm, but also in the spleen.
• Stage IV tends to be more widespread disease, where the cancer has spread to at least one organ outside of the lymph system, such as the lung, liver, or bone marrow.

Treating Lymphoma By Stage

The stage is more important for managing some types of lymphomas than others, Dr. Piro says. For some of the more common types of non-Hodgkin lymphoma, doctors determine what treatment to use by grouping the cancer into one of two categories "early" (stage I or stage II) or "advanced" (stage III or stage IV).

For example, to treat an early-stage diffuse large B-cell lymphoma, doctors give three to six cycles of the drug combination called R-CHOP, possibly followed by radiation to the affected lymph nodes. But for an advanced stage of the same cancer, they'll often give six cycles of R-CHOP, followed by injections of chemotherapy or high-dose chemotherapy and a stem cell transplant.

People with an early-stage follicular lymphoma will typically get radiation to the affected lymph nodes, or sometimes chemotherapy plus the monoclonal antibody drug, rituximab (Rituxan). In the advanced stages, treatment involves a combination of a monoclonal antibody plus one or more chemotherapy drugs.

For other types of non-Hodgkin lymphoma, including faster-growing varieties such as Burkitt lymphoma, the stage doesn't have as much of an impact on treatment decisions.

What Your Stage Means to Your Outlook

Lymphocytes travel through an interconnected network of vessels and tissues, which makes it easy for them to spread. This is why it's common for people to be diagnosed when their cancer is already at an advanced stage, Dr. Piro tells SurvivorNet.

The good news is that non-Hodgkin lymphoma stages don't reflect survival as much as other cancers, where a stage IV diagnosis can be dire. The stages of lymphoma often can be treated equally well, Dr. Piro says. And for many of these cancers, the prognosis is similar at all stages. For example, people with an early-stage follicular lymphoma are 96% as likely to be alive five years later as people who don’t have this cancer. Those with a later-stage lymphoma are 85% as likely to still be alive five years later.

When your doctor assigns your cancer a stage, ask what it will mean for your treatment, and how it might affect your outlook. And if you do have a late-stage lymphoma, in addition to the standard treatments your doctor has available, ask your medical team whether it makes sense for you to enroll in a clinical trial of a new type of therapy.

 

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