Hodgkin lymphoma (sometimes called Hodgkin’s lymphoma) is a form of cancer that affects the immune system. It starts in the white blood cells, but what patients and doctors will most likely notice first is a lump in the neck, under the arm, or in the groin.
How is Hodgkin lymphoma staged?
Hodgkin lymphoma is staged based on where in the body the lymphoma appears. Staging of cancer generally indicates how advanced the disease is because, as the cancer grows, it can also spread into new areas. Hodgkin lymphoma can spread from one part of the lymph system to another and another, and then eventually to other parts of the body.
There are four stages:
- Stage I: The lymphoma is in one place, such as in the lymph system under the arms or on the side of the neck.
- Stage II: It is in two places on one side of the diaphragm (the muscle that separates the chest from the abdomen), such as on both sides of the neck.
- Stage III: It is involving the lymph system above and below the diaphragm.
- Stage IV: When the disease involves an organ that is not a lymph node, such as the liver, lungs, or bones.
Another layer of staging considers symptoms and separates each stage into two parts, A and B, such as stage IA or stage IB.
If a patient is experiencing symptoms such as fevers, shaking chills, drenching night sweats, or unintentional weight loss, then their stage would include a B, such as stage IB or IIB. The symptoms must be pronounced. If a patient has none of these symptoms, their stage will include an A, such as Stage IA or IIA.
“When discussing B symptoms, chills are more than just feeling cold. Patients must have shaking chills that are persistent,” says Reid Merryman, MD, a lymphoma specialist and physician in the Center for Hematologic Oncology at Dana-Farber. “Drenching night sweats occur when a patient has to change their clothes or sheets.”
How is a patient’s stage of lymphoma determined?
Staging of Hodgkin lymphoma typically involves a PET scan. According to Merryman, all patients should have a PET scan before starting treatment. The scan will show where the lymphoma is in the body.
At Dana-Farber, oncologists first confirm that a patient has Hodgkin lymphoma by having a pathologist review a biopsy. Then they use PET scan results and an assessment of symptoms for staging and to guide treatment selection.
What are the treatment options for Hodgkin lymphoma?
Staging is one factor that helps oncologists select treatment for Hodgkin lymphoma. For many forms of cancer, later stage disease is harder to treat. But for Hodgkin lymphoma, the goal of treatment is cure for all stages of the disease.
“We treat Hodgkin lymphoma with the goal of cure regardless of stage,” says Merryman.
The treatment for Hodgkin lymphoma is different for early stage (stages I and II) than it is for advanced stage (stages III and IV). Early stage disease is further separated into favorable and unfavorable risk groups based on the number of sites involved, the size of involved lymph nodes, age, symptoms, and blood work. Most patients with Hodgkin lymphoma (in all of these groups) can be cured with initial therapy for their lymphoma.
Learn more about how Dana-Farber selects treatment for Hodgkin lymphoma here.
Learn more about diagnosing and staging Hodgkin lymphoma here.
About the Medical Reviewer
Dr. Merryman received his undergraduate degree from the University of Notre Dame and his medical degree from Harvard Medical School. He completed residency training in internal medicine at Brigham and Women's Hospital and fellowship training in hematology and oncology at Dana-Farber/Partners Cancer Care. He is an attending physician in the Lymphoma Program at Dana-Farber Cancer Institute. His research focuses on the development of immune-based therapies for patients with lymphoma.