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Stage Information


Current practice is to assign a clinical stage (CS) based on the findings of the clinical evaluation and a pathologic stage (PS) based on the findings of invasive procedures.

For example, a patient who has disease in the chest and neck, systemic symptoms, and a negative lymphangiogram might be found at laparotomy to have involvement of the spleen, liver, and bone marrow. Thus, the precise stage of such a patient would be CS IIB, PS IVB (S+)(H+)(M+).


Stage I adult HL is characterized by the involvement of a single lymph node region (I) or localized involvement of a single extralymphatic organ or site (IE).


Stage II adult HL is characterized by the involvement of two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of a single associated extralymphatic organ or site and its regional lymph node(s) with or without involvement of other lymph node regions on the same side of the diaphragm (IIE). Note: The number of lymph node regions involved may be indicated by a subscript.


Stage III adult HL is characterized by the involvement of lymph node regions on both sides of the diaphragm (III), which may also be accompanied by localized involvement of an associated extralymphatic organ or site (IIIE), by involvement of the spleen (IIIS), or by involvement of both (IIIE + S). Stage III disease may be subdivided by anatomic distribution of abdominal involvement or by extent of splenic involvement. Stage III(1) indicates involvement that is limited to the upper abdomen above the renal vein. Stage III(2) indicates involvement of pelvic and/or para-aortic nodes. Five or more visible splenic nodules on a cut section constitutes extensive splenic involvement. Zero to four nodules is classified as minimal splenic disease.


Stage IV adult HL is characterized by disseminated (multifocal) involvement of one or more extralymphatic organs, with or without associated lymph node involvement, or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement.

Massive mediastinal disease has been defined by the Cotswolds meeting as a thoracic ratio of maximum transverse mass diameter of 33% or more of the internal transverse thoracic diameter measured at the T5/6 intervertebral disc level on chest radiography.[1] Some investigators have designated a lymph node mass measuring 10 cm or more in greatest dimension as massive disease.[12] Other investigators use a measurement of the maximum width of the mediastinal mass divided by the maximum intrathoracic diameter.[13]

Many investigators and many new clinical trials employ a clinical staging system that divides patients into three major groups that are also useful for the practicing physician:[14]

  • EARLY FAVORABLE: Clinical stage I or II without any risk factors.
  • EARLY UNFAVORABLE: Clinical stage I or II with one or more of the following risk factors:
    • Large mediastinal mass (>33% of the thoracic width on the CXR, =10 cm on CT scan).
    • Extranodal involvement.
    • Elevated ESR (>30 mm/hr for B stage, >50 mm/hr for A stage).
    • Three or more lymph node areas' involvement.
    • B symptoms.
  • ADVANCED: Clinical stage III or IV. For patients with advanced-stage HL, the International Prognostic Factors Project has developed an International Prognostic Index with a prognostic score that is based on seven adverse factors:[15]
    • Albumin level of less than 4.0 g/dL.
    • Hemoglobin level of less than 10.5 g/dL.
    • Male sex.
    • Age of 45 years or older.
    • Stage IV disease.
    • White blood cell (WBC) count of at least 15,000/mm3.
    • Absolute lymphocytic count of less than 600/mm3 or a lymphocyte count that was less than 8% of the total WBC count.

WebMD Public Information from the National Cancer Institute

Last Updated: March 12, 2007
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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