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Staging means finding out how far cancer has spread in your body. Physicians group non-Hodgkin lymphoma (NHL) into stages I (1) through IV (4). The stage depends on where the cancer is in your lymph system and if it has spread to parts of your body outside your lymph system.
When your Fred Hutch Cancer Center team designs your treatment plan, they will take into account the stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.
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What are the stages of non-Hodgkin lymphoma?
Stage I (1)
Cancer is in only one group of lymph nodes or in only one of these places: Waldeyer’s ring (tonsils, adenoids and other lymphoid tissue in the throat), your thymus or your spleen.
Stage IE: Cancer is in one place outside your lymph system. (“E” stands for “extralymphatic” or “extranodal.”)
Stage II (2)
Cancer is in two or more groups of lymph nodes, both above or both below your diaphragm.
Stage IIE: Cancer has spread from a group of lymph nodes to a nearby place outside your lymph system. Cancer may also be in other groups of lymph nodes on the same side of the diaphragm.
Stage III (3)
Cancer is in lymph nodes on both sides of your diaphragm — or cancer is in lymph nodes above your diaphragm, and it’s also in your spleen.
Stage IV (4)
Cancer has spread to other parts of the body. Each of these is stage IV:
- Cancer is throughout one or more organs outside your lymph system.
- Cancer is in two or more groups of lymph nodes, all on the same side of your diaphragm, and it’s also in an organ that is outside your lymph system and is not near your affected lymph nodes.
- Cancer is in groups of lymph nodes both above and below your diaphragm and in an organ outside your lymph system.
- Cancer is in your liver, your bone marrow, your cerebrospinal fluid or more than one place in your lung. It didn’t spread there directly from nearby lymph nodes.
What causes non-Hodgkin lymphoma?
The exact cause of NHL is not known. But generally speaking, cancer happens because of changes (mutations) in cell DNA.
- DNA is the chemical that makes up your genes.
- Genes control when your cells grow, divide into new cells and die.
- DNA mutations can cause cells to grow abnormally and lead to cancer if:
- They turn on genes that help cells grow and divide (oncogenes).
- They turn off genes that slow cell division or make cells die when they should (tumor-suppressor genes).
- They turn off genes that help fix problems in DNA (DNA repair genes).
Studies show that certain factors are linked to increased risk. Some of these risk factors are things you can’t change, such as getting older, having a family history of NHL or having certain autoimmune conditions. Other factors relate to your lifestyle, so you may be able to change them. For example, excess body weight may increase risks.
Learn more about NHL risk and prevention.
Non-Hodgkin Lymphoma Survival Rates
In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during that five year span for some other reason. For NHL, the relative five-year survival rate overall in the United States is 74.3%, according to the National Cancer Institute.
But the chance of surviving cancer for five years or more can be quite different from person to person. One important reason is the stage of the disease at the time of diagnosis. For stage I NHL, the relative five-year survival rate is about 87%. For stage IV NHL, the rate is about 64%. Even within a subset of people, there will be differences. Patients may have different subtypes of NHL, have different treatments and respond to treatments in different ways.
This means it’s impossible to predict the likely lifespan of any one person based on survival rates. If you would like to know more about the outlook for your disease, talk with your Fred Hutch care team. They can tell you more based on your unique situation.
Within a certain subtype of NHL, your treatment plan may vary based on the stage of the disease. But treatment varies from one subtype to another. So, there’s no simple way to say what physicians recommend for NHL overall, stage by stage. This is one reason it’s so important to find out your subtype and to get care from NHL experts who know how to treat each one. Your Fred Hutch care team can explain which treatments are recommended for your subtype and stage.
Physicians and scientists at Fred Hutch and beyond are working to discover and develop new ways to treat advanced lymphoma. They’re studying a wide range of approaches in clinical trials. These include different chemotherapy regimens, new targeted therapies and immunotherapies, better ways to use radiation therapy or blood and marrow transplant, and new ways to combine treatments. Learn about NHL treatment.
All stages can be treated. The stage has to do with where the lymphoma is in your body. Stage IV NHL has spread further than stage I, but it may still respond well to treatment. Some subtypes respond better than others to today’s therapies and new therapies are being developed. Ask your care team to explain what’s possible with your subtype and stage.