Stages of non-Hodgkin lymphoma

The stages of non-Hodgkin lymphoma (NHL) tell you about the number and places in the body that are affected by lymphoma.

Knowing the stage helps your doctor to decide what treatment you need. Your doctor will also ask you about your symptoms.

The Lugano classification is used to stage lymphoma. There are 4 stages. Or these can be simplified into limited (early) or advanced stage.

Other staging systems

There are different staging systems for skin lymphoma and childhood NHL. If your child has NHL, ask your specialist to explain their stage.

Read about skin lymphoma and the different stages.

How doctors work out your stage

Doctors look at whether the lymphoma is:

• on one side, or both sides of your ​diaphragm​

• inside or outside the ​lymphatic system​

• the size of the lymphoma

They do this by carrying out various tests, such as a ​CT​ or ​PET-CT scan​ .

The diaphragm

The diaphragm (pronounced dia-fram) is the big breathing muscle that separates the chest from the tummy (abdominal) area. 

Doctors use the diaphragm as a guide because it is about halfway down the body.

Inside or outside of the lymphatic system

Doctors look at whether your lymphoma is affecting your ​lymph nodes​  and organs inside the lymphatic system. These are called lymphatic sites. If it is affecting areas outside the lymphatic system they are called extranodal sites.

Lymphatic sites

Lymphatic sites include a group of lymph nodes or an organ in the lymphatic system, such as the:

• ​thymus​

• ​spleen​

• tonsils

Extranodal sites

Extranodal sites are sometimes called extralymphatic sites. They are outside the lymphatic system and include the:

• lungs

• liver

• blood

• ​bone marrow​

• kidneys

• brain

Your doctor may use the letter E (for extranodal) after the stage number if you have lymphoma outside the lymphatic system. For example stage 1E. Your doctor or nurse can explain what this means for you.

Bulky disease

This means that you have areas of lymphoma that measure above a certain size. The exact measurement depends on your type of NHL.

For example, in follicular lymphoma, bulky disease measures over 6 cm. In diffuse large B cell lymphoma, bulky disease is usually greater than 10 cm.

Stage 1

This means that you have one of the following:

• lymphoma in a single lymph node or one group of lymph nodes, or an organ of the lymphatic system (such as the thymus)

• lymphoma in an extranodal site (this is called stage 1E)

Below is an example of stage 1 lymphoma. 

Stage 2

This means one of the following:

• your lymphoma is in two or more groups of lymph nodes

• your lymphoma is in an extranodal site and one or more groups of lymph nodes (this is called stage 2E)

In both cases, the 2 sites of lymphoma are on the same side of the diaphragm.

Below is an example of stage 2.

Stage 3

This means that you have lymphoma on both sides of the diaphragm.

Below is an example of stage 3. The lymphoma is in lymph nodes above the diaphragm and the spleen.

Stage 4

Stage 4 means one of the following:

• lymphoma is in the lymph nodes and an extranodal site

• lymphoma is in more than one extranodal site, for example the liver, bones or lungs

Below is an example of stage 4 lymphoma.

These stages made simple

Your doctor may describe your lymphoma as being:

• limited or early stage

• advanced stage

Limited stage

Limited disease generally means you have stage 1 or stage 2 NHL. Doctors also call this early stage NHL.

Advanced stage

Advanced disease means you have stage 3 or stage 4 NHL.

Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.

You doctor or specialist nurse can explain what stage you have and what this means in your situation.