The stage of Hodgkin lymphoma describes the extent of the spread of the tumor, using the terms "stage I" to "stage IV" 1 through 4. Stage I: The lymphoma is found in 1 lymph node region. Stage II: The lymphoma is in 2 or more lymph node regions on the same side of the diaphragm. Stage IIE: The lymphoma involves 1 organ and its regional lymph nodes lymph nodes located near the site of the lymphoma , with or without lymphoma in other lymph node regions on the same side of the diaphragm.
The mass is either larger than one-third the diameter of the chest or larger than 10 centimeters cm. A centimeter is roughly equal to the width of a standard pen or pencil. Stage III: There is lymphoma in lymph node areas on both sides of the diaphragm, meaning above and below it. Stage IV: The lymphoma has spread to 1 or more organs beyond the lymph nodes. Hodgkin lymphoma usually spreads to the liver, bone marrow, or lungs.
Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur at any time, including shortly after the first treatment or years later. If the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence.
These tests and scans are often similar to those done at the time of the original diagnosis. In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how well this treatment will work.
For people with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. The lymphoma may be described as "high-risk disease" or "low-risk disease" based on how many of the following prognostic factors there are.
Other prognostic factors that are considered, especially for early-stage Hodgkin lymphoma, include:. A higher erythrocyte sedimentation rate, or ESR see "Laboratory tests" in Diagnosis , is associated with a poorer prognosis. People with lymphocyte-predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte-rich classic Hodgkin lymphoma have a better prognosis, compared with other types of Hodgkin lymphoma.
All other lymphomas—those that do not have Reed-Sternberg cells—are lumped into a category called non-Hodgkin lymphoma NHL. There are more than 30 different types of NHL.
Some forms are treated differently than others. CHOP also works against other NHL sub-types that fall within the same category as anaplastic large cell lymphoma, known as peripheral T cell lymphomas.
This fast-growing lymphoma accounts for about one third of NHL cases. For this lymphoma, it is typical for lymph nodes to double in size every month, and patients often present within a few months of having noted an enlarged lymph node. Unfortunately for those patients who are not cured by R-CHOP there are less attractive second line therapies, including chemotherapy or high dose chemotherapy followed by autologous stem cell rescue, also known as bone marrow transplant.
Many fewer can be cured at that point and the majority of these patients will not survive their disease. The second most common subtype of NHL, follicular lymphoma FL , grows slowly, with lymph nodes doubling in size approximately every six to 12 months, and patients often get diagnosed a year or later after they first noted an enlarged lymph node.
There are no routine screenings for lymphoma. If a person has persistent viral symptoms, they should seek medical consultation.
They will also carry out a physical examination, including an inspection of the abdomen and chin, neck, groin, and armpits, where swellings may occur. The doctor will look for signs of infection near lymph nodes since this can account for most cases of swelling. Blood tests and biopsies: These can detect the presence of lymphoma and help a doctor distinguish between different types. A biopsy involves a surgeon taking a sample of lymph tissue.
The doctor will then send it for examination in a laboratory. The surgeon may remove a small section or all of a lymph node. In some cases, they might use a needle to take a tissue sample. It might be necessary to carry out a bone marrow biopsy. This may require a local anesthetic, a sedative, or a general anesthetic. Biopsies and other tests can confirm the stage of the cancer to see whether it has spread to other parts of the body.
A spinal tap: In this procedure, a surgeon uses a long, thin needle to remove and test spinal fluid under local anesthetic. Staging of the cancer depends on the type, growth rate, and cellular characteristics. In stage 0 or 1, the cancer stays in a confined area. By stage 4, it has spread to more distant organs, and doctors find it more challenging to treat. A doctor may also describe lymphoma as indolent, meaning that it remains in one place.
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