Grading and staging of non-Hodgkin’s lymphomas

Knowing the grade and stage of a lymphoma helps the doctors to know how the lymphoma is likely to develop, how it may affect you and which treatment is most appropriate.

Grading

Grading refers to the appearance of the lymphoma cells under the microscope. The grade gives an idea of how quickly the lymphoma may grow and develop. Most non-Hodgkin’s lymphomas fall into one of two main categories:

Low-grade (or slow-growing) These have a very slow growth rate and may need little or no treatment for months or possibly years. When they do need treatment they are likely to shrink down, or even disappear completely, but are likely to come back again at some time in the future.

High-grade (or faster-growing) These types grow more quickly. They are more likely to cause symptoms and usually need immediate treatment. However, they are more likely to be completely cured than low-grade lymphomas. The usual treatment is intensive chemotherapy.

Staging

The stage of a lymphoma is a term used to describe where it is in the body, how many lymph glands are affected and whether it has spread to other lymph glands or other organs. A commonly used staging system is described below:

Stage 1 One group of lymph nodes is affected.

Stage 2 Two or more groups of nodes are affected, but the lymphoma is only on one side of the diaphragm. The diaphragm is the sheet of muscle under the lungs that plays a large part in our breathing. The part of the body above the diaphragm is considered the upper half, and below the diaphragm is considered the lower half of the body.

Stage 3 The lymphoma is in lymph nodes on both sides of the diaphragm.

Stage 4 The lymphoma has spread beyond the lymph nodes, for example to other organs such as the bone marrow, liver or lungs.

As well as giving each stage a number, doctors also use a letter code – either A or B – to show whether or not you have specific symptoms. Your doctor will ask you whether you have lost weight or have fevers or night sweats. If you do not have any of these symptoms, your lymphoma will be classified as A. If you have these symptoms, it is B.

Occasionally, lymphomas can occur at unusual sites outside the lymph nodes, for example in the stomach. This is called extranodal lymphoma and the stage will include the letter E (for extranodal)

Once your doctor knows the type of lymphoma and the stage and grade, they can plan the most effective treatment for you.