Adult Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Adult Hodgkin Lymphoma
Table 1. Notations for Identifying Sites
|N = nodes||H = liver||L = lung||M = bone marrow|
|S = spleen||P = pleura||O = bone||D = skin|
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+).
The American Joint Committee on Cancer (AJCC) has designated staging using the Ann Arbor classification system to define adult Hodgkin lymphoma.
Table 2. Anatomic Stage/Prognostic Groupsa
|a Reprinted with permission from AJCC: Hodgkin and non-Hodgkin lymphomas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 607-11.|
|I||Involvement of a single lymphatic site (i.e., nodal region, Waldeyer ring, thymus or spleen) (I).|
|Localized involvment of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma).|
|II||Involvement of ≥2 lymph node regions on the same side of the diaphragm (II).|
|Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement with or without involvement of other lymph node regions on the same side of the diaphragm (IIE).|
|The number of regions involved may be indicated by an arabic numeral, as in, for example, II3.|
|III||Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE, S).|
|Splenic involvement is designated by the letter S.|
|IV||Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph node involvement.|
|Isolated extralymphatic organ involvement in the absence of adjacent regional lymph node involvement, but in conjunction with disease in distant site(s).|
|Stage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid.|
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. Some investigators have designated a lymph node mass measuring 10 cm or more in greatest dimension as massive disease. Other investigators use a measurement of the maximum width of the mediastinal mass divided by the maximum intrathoracic diameter.