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Hodgkin Lymphoma Staging

Doctors use physical examinations, imaging tests, blood test and, sometimes, bone marrow tests to determine the extent of the disease.  This determination is called "staging."  Staging provides important information for treatment planning.

Staging for Hodgkin lymphoma is based on the Lugano classification, which is derived from the Ann Arbor staging system.

Hodgkin Lymphoma Stages


Stage I

HL cells found in a single lymph node region (this can include one node or a group of adjacent nodes) above the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen), OR

HL cells found in one organ or site outside the lymphatic system.

Stage II

HL cells found in two or more lymph node regions on the same side of the diaphragm, either above the diaphragm or below the diaphragm, OR

HL cells found in a lymph node area and a nearby organ outside the lymphatic system, on the same side of the diaphragm

Stage III HL cells found in lymph node regions on both sides of the diaphragm (above and below), possibly with localized involvement of an organ outside the lymphatic system or the spleen
Stage IV

HL cells have spread widely into one or more organs outside the lymphatic system and possibly into nearby lymph nodes, OR

HL cells found in one organ outside the lymphatic system and also in distant lymph nodes 


In addition to the stage number, the letters A, B, E or S may be used to further classify the stage of HL.

  • Category A: The patient does not have B symptoms (fever, weight loss or night sweats).
  • Category B: The patient has B symptoms.
  • Category E: The patient has HL cells in organs or tissues outside the lymphatic system.
  • Category S: The patient has HL cells in the spleen.

For example, stage IIB would indicate that the patient has

  • Involvement of two lymph node sites near each other (for example, enlarged lymph nodes in the neck and collarbone area or in the neck and the armpit)
  • Fever, excessive sweating and/or weight loss

Patients in the B category sometimes require more aggressive treatments. It is important to note that even patients with stage IV (advanced stage) HL are frequently cured with treatment, despite having lymphoma in many areas of the body.

Related Links

  • Download or order The Leukemia & Lymphoma Society's free booklet, Hodgkin Lymphoma.