What is the stage of Hodgkin lymphoma (Hodgkin's lymphoma) with lymphadenopathy (enlargement of lymph nodes) on both sides of the diaphragm?

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Last updated: March 11, 2025View editorial policy

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From the Guidelines

Hodgkin lymphoma with lymphadenopathy on both sides of the diaphragm is classified as Stage III disease. This staging indicates that the lymphoma has spread to lymph node regions on both sides of the diaphragm, meaning it involves lymph nodes both above and below the diaphragm. The Ann Arbor staging system is used for Hodgkin lymphoma, with stages ranging from I to IV. Stage III specifically denotes disease that has spread to lymph node regions or structures on both sides of the diaphragm, which may include involvement of the spleen.

Key Points to Consider

  • The Ann Arbor staging system is the standard classification system used for Hodgkin lymphoma, as described in the studies 1.
  • Stage III Hodgkin lymphoma generally has a good prognosis with modern treatment regimens, though specific treatment recommendations would depend on additional factors such as the patient's age, overall health status, and histologic subtype of Hodgkin lymphoma.
  • Further evaluation with PET/CT imaging would be important to confirm the extent of disease and to serve as a baseline for assessing treatment response.

Staging Classification

The staging classification for Hodgkin lymphoma is as follows:

  • Stage I: Involvement of a single lymphatic region or localized involvement of single extralymphatic organ or site.
  • Stage II: Involvement of two or more lymphatic regions on the same side of the diaphragm or localized involvement of a single extralymphatic organ or site and of one or more lymphatic regions on the same side of the diaphragm.
  • Stage III: Involvement of lymphatic regions on both sides of the diaphragm.
  • Stage IV: Diffuse or disseminated involvement of one or more extralymphatic organs with or without lymphatic involvement, as outlined in the studies 1.

Importance of Accurate Staging

Accurate staging is crucial for determining the appropriate treatment approach and predicting outcomes in patients with Hodgkin lymphoma. The Ann Arbor staging system provides a standardized framework for classifying the extent of disease, which helps guide treatment decisions and facilitates communication among healthcare providers, as noted in the study 1.

From the Research

Stage of Hodgkin Lymphoma

The stage of Hodgkin lymphoma with lymphadenopathy on both sides of the diaphragm is:

  • Stage III, as indicated by lymph node involvement on both sides of the diaphragm 2

Characteristics of Stage III Hodgkin Lymphoma

Some key characteristics of Stage III Hodgkin lymphoma include:

  • Lymph node involvement on both sides of the diaphragm
  • May or may not have typical B symptoms such as weight loss, fever, and night sweats
  • Requires careful examination and consideration of additional tissue diagnoses in atypical presentations of new masses or lymphadenopathy on the opposite side of the diaphragm 2

Treatment of Hodgkin Lymphoma

Treatment of Hodgkin lymphoma depends on the stage and other factors, and may include:

  • Chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) 3, 4, 5, 6
  • Radiation therapy, which may be omitted in patients with interim PET-negative disease 6
  • High-dose chemotherapy supported by autologous stem cell transplantation for patients with relapsed or refractory disease 3

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hodgkin lymphoma.

Critical reviews in oncology/hematology, 2013

Research

Treatment of stage I and II Hodgkin's lymphoma with ABVD chemotherapy: results after 7 years of a prospective study.

Annals of oncology : official journal of the European Society for Medical Oncology, 2004

Research

Positron Emission Tomography-Adapted Therapy in Bulky Stage I/II Classic Hodgkin Lymphoma: CALGB 50801 (Alliance).

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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