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Lymphomas
Staging and Prognosis
 Once someone is diagnosed with lymphoma and before beginning treatment, doctors must determine how far the disease has spread and what areas of the body are affected by running a series of tests to stage the lymphoma. The choice of treatment and the prognosis (likelihood of cure) for the patient are based on the stage of the disease.
Initially, your doctor will perform a physical exam to look for enlarged lymph nodes. Other tests and procedures may include a pathology report, blood tests, chest x-ray, computed tomography (CT) or magnetic resonance imaging (MRI) scans of the abdomen, chest and pelvis; a bone marrow biopsy (a sampling of marrow for examination under a microscope) and a positron-emission (PET) scan. CT scans are quite accurate in detecting swollen lymph nodes and lymphoma tumors in the liver and other organs. PET scans are the most sensitive in determining the stage of the disease and evaluating the response to treatment.
Staging and Prognosis
The Ann Arbor Staging System is the most commonly used classification system for staging lymphoma. (See Table 1.)
The International Prognostic Index (IPI) is another tool used by oncologists to predict the risk of disease recurrence and overall survival in patients with aggressive forms of lymphoma. It takes into account the age and general health of the patient, the stage of the disease, the number of involved sites or organs outside the lymph nodes, and the presence or absence of elevated levels in the blood of an enzyme called lactate dehydrogenase.
The index assigns one point for each of the following risk factors: age greater than 60 years, late-stage disease (stages III or IV), involvement of more than one organ or site outside the lymph nodes, high levels of lactate dehydrogenase in the blood and poor general health. The lower the score from zero to 5, the better the predicted outcome from treatment. Patient outcomes from treatment for lymphoma have been steadily increasing over the last few decades. Recent clinical trials of new types of chemotherapy have indicated high survival rates.
Table 1. Stages of Lymphoma
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Stage I |
The disease is limited to one lymph node region, that is, an area of the body containing groups of lymph nodes that drain lymph fluid, such as the neck, armpits or groin; or a single site or organ other than a lymph node (extranodal). |
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Stage II |
The disease involves two or more lymph node regions on the same side of the diaphragm above or below; for example, enlarged nodes in the neck and in the armpit. Or, involvement of one organ or site outside the lymphatic system with spread to one or more lymph node regions on the same side of the diaphragm. |
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Stage III |
The disease involves lymph node regions above and below the diaphragm; for example, some enlarged nodes in the groin and some in the neck, with or without involvement of the spleen or an organ or site or both outside the lymphatic system. |
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Stage IV |
The disease involves other parts of the body, such as bone marrow, the lungs or liver, with or without lymph node involvement. |
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