Stages of Childhood Hodgkin's Lymphoma

by National Cancer Institute

(Page 2 of 3)

After childhood Hodgkin's lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI of the abdomen and pelvis may be done.

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for abnormal cells.

The letters "E" and "S" may be used to describe the stages of childhood Hodgkin's lymphoma.

E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.

S: Cancer is found in the spleen.

The following stages are used for childhood Hodgkin's lymphoma:

Stage I

Stage I is divided into stage I and stage IE.

Stage I: Cancer is found in one group of lymph nodes.

Stage IE: Cancer is found in one group of lymph nodes and has spread to a nearby organ or tissue that is not part of the lymph system.

Stage II

Stage II is divided into stage II and stage IIE.

Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm.

Stage IIE: Cancer is found in two or more lymph node groups on the same side of the diaphragm and has spread from one of those lymph nodes to a nearby organ or tissue that is not part of the lymph system.

Stage III

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E.

Stage III: Cancer is found in lymph node groups on both sides of the diaphragm.

Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and has spread from one of these lymph nodes to a nearby organ or tissue that is not part of the lymph system.

Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.

Stage IIIE+S: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen, and has spread from one of these lymph node groups to a nearby organ or tissue that is not part of the lymph system.

Stage IV

In stage IV: cancer is found throughout one or more organs that are not part of the lymph system and may be in lymph nodes near those organs; or cancer is found throughout one organ that is not part of the lymph system and in lymph nodes far away from that organ.

Untreated, classical Hodgkin's lymphoma is divided into risk groups.

Untreated, classical childhood Hodgkin's lymphoma is divided into risk groups based on the bulk of the tumor (tumors that are 5 centimeters or larger are considered "bulky") and whether the patient has "b" symptoms (fever, weight loss, or night sweats). Treatment is based on the risk group.

Low-risk disease:

• Patients with stage I or stage II disease; and
• No bulky tumors or "b" symptoms.

Intermediate-risk disease:

• Patients with stage I or stage II disease, with bulky tumors, or with "b" symptoms; or
• Patients with stage III or stage IV disease without "b" symptoms.

High-risk disease: Patients with stage III or stage IV disease with "b" symptoms.

Childhood Hodgkin's lymphoma is staged again after initial chemotherapy.

A PET or gallium scan is done after chemotherapy ends to find out how well the chemotherapy worked.

Primary Progressive/Recurrent Hodgkin's Lymphoma in Children and Adolescents

Primary progressive Hodgkin's lymphoma is lymphoma that continues to grow or spread during treatment. Recurrent Hodgkin's lymphoma is cancer that has recurred (come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow.

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