Hodgkin Lymphoma: Stages

April 18, 2018

Hodgkin Lymphoma: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find the location, growth, and spread of the cancer. Your provider can also tell if it is affecting other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The Lugano classification for Hodgkin lymphoma

The staging system used for Hodgkin lymphoma has four stages. Each stage can have a value of a Roman numeral of I through IV (1 through 4). The higher the number, the more advanced the cancer is.

A letter may also be added after the Roman numeral to give more information. Here's what the letters mean:

  • is added if you have any of these symptoms (called B symptoms):

    • Unexplained fever of at least 100.4°F (38°C)

    • Drenching night sweats

    • Weight loss without dieting

  • means you don’t have any B symptoms.

  • means the lymphoma has spread to an organ outside the lymphatic system.

  • is added if you have bulky disease. This means that a tumor in your chest is at least 1/3 as wide as your chest. Or it means that tumors in other areas are more than about 4 inches (10 cm) across.

What are the stage groupings of Hodgkin lymphoma?

The stage groupings of Hodgkin lymphoma are: 

Stage I. The cancer is either of the following:

  • The lymphoma is in only one group of lymph nodes, or it's in one organ where lymphatic tissue is found, such as the thymus (stage I).

  • The cancer is only found in one organ outside the lymphatic system and hasn’t spread to any other part of the body (stage IE).

Stage II. The cancer is either of the following:

  • The lymphoma is in two or more groups of lymph nodes on the same side of the diaphragm, either above or below it (stage II). The diaphragm is a thin band of muscle that separates the chest and belly or abdomen.

  • The cancer started in one group of lymph nodes and is now also in a nearby organ (stage IIE).

Stage III. The cancer is either of the following:

  • The cancer is in lymph nodes on both sides of the diaphragm, both above and below it (stage III).

  • The cancer is in lymph nodes above the diaphragm and in the spleen.

Stage IV. The lymphoma has spread to one or more organs outside of the  lymphatic system, such as the liver, bone marrow, and/or lungs.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.


April 18, 2018


Lugano classification for staging of lymphomas (derived from Ann Arbor staging with Cotswolds modifications). UpToDate., Staging and prognosis of Hodgkin lymphoma. UpToDate.

Reviewed By:  

Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS