From the Guidelines
Hodgkin lymphoma staging is based on the Cotswolds classification, a modification of the Ann Arbor staging system, which categorizes the disease into stages I to IV, with additional risk factors influencing treatment decisions. The staging procedure includes a comprehensive evaluation, such as bone marrow biopsy and CT scans of the abdomen and thorax, as recommended by the European Society for Medical Oncology 1. The stages are defined as follows:
- Stage I: involvement of a single lymph node region or single extralymphatic site
- Stage II: involvement of two or more lymph node regions on the same side of the diaphragm
- Stage III: lymph node involvement on both sides of the diaphragm
- Stage IV: disseminated disease with extralymphatic organ involvement, such as bone marrow, liver, or lungs Additional risk factors, including large mediastinal mass, extranodal disease, high ESR, and three or more involved lymph node areas, are used to allocate patients to different risk groups, such as early favorable, early unfavorable, and advanced risk groups 1. Accurate staging is crucial, as it directly influences treatment approach, with early-stage disease often treated with combined chemoradiotherapy, and advanced disease typically requiring more intensive chemotherapy regimens 1.
From the Research
Stages of Hodgkin Lymphoma
The stages of Hodgkin lymphoma are typically classified using the Ann Arbor classification system, which includes four stages:
- Stage I: The disease is limited to one lymph node group (e.g., neck, underarm, groin, etc.) or lymphoid organ (e.g., spleen, tonsils, etc.) 2, 3.
- Stage II: The disease is limited to two or more lymph node groups on the same side of the diaphragm 2, 3.
- Stage III: The disease is limited to lymph node groups on both sides of the diaphragm 2, 3.
- Stage IV: The disease has spread to one or more organs or tissues outside of the lymphatic system, such as the liver, bone marrow, or lungs 2, 3.
Prognostic Factors
In addition to the stage of the disease, other prognostic factors are used to determine the risk of recurrence and guide treatment decisions, including:
- The presence or absence of certain symptoms, such as fever, weight loss, or night sweats 4.
- The type of Hodgkin lymphoma, with classical Hodgkin lymphoma being more common and nodular lymphocyte-predominant Hodgkin lymphoma being less common 4, 5.
- The patient's age and overall health 5.
Diagnosis and Staging
The diagnosis and staging of Hodgkin lymphoma typically involve a combination of:
- Biopsy to analyze the architecture of the lymph node 5.
- Positron emission tomography (PET) scan to evaluate the extent of the disease 4, 5.
- Bone marrow biopsy, although this is no longer routinely performed as part of initial staging 5.
- Cardiac ultrasound and pulmonary function tests to assess the patient's overall health and potential risks associated with treatment 5.