Hodgkin's lymphoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]


According to the Lugano classification and Cotswold's modification of the original Ann arbor staging system, there are four stages of Hodgkin's lymphoma based on the number of nodes and extranodal involvement.


According to the Lugano classification[1] and Cotswold's modification of the original Ann arbor staging system,[2][3] there are four stages of Hodgkin's lymphoma based on the number of nodes and extranodal involvement.

Staging for Hodgkin's lymphoma is provided in the following tables:

Revised staging system for primary nodal lymphomas (Lugano classification)
Stage Involvement Extra nodal (E) status
I One node or a group of adjacent nodes Single extra nodal lesions without nodal involvement
II Two or more nodal groups on the same side of the diaphragm Stage I or II by nodal extent with limited contiguous extra nodal involvement
II bulky* II as above with "bulky" disease Not applicable
III Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement Not applicable
IV Additional noncontiguous extra lymphatic involvement Not applicable

Cotswold's modification of the original Ann arbor staging system
Stage Involvement
stage I
I One nodal group or lymphoid organ (e.g. spleen or thymus)
IE One extra nodal site
stage II
II Two or more nodal groups, same side of diaphragm
II E Localized extra nodal site with stage II criteria, both on the same side of the diaphragm
stage III
III Nodal groups on both sides of the diaphragm
III S (1) With splenic involvement
III E (2) With localized extra nodal site
stage IV
IV Disseminated involvement of one or more extra lymphatic organ (e.g. lung, bone) +/- any nodal involvement
Additional staging variables
X Bulky nodal disease: nodal mass >1/3 of intra thoracic diameter or 10 cm in dimension
A Asymptomatic
B Presence of B symptoms (fever, night sweats and weight loss)
E Extra nodal: other than the lymph nodes or spread to tissues beyond, but nearby, the lymphatic tissues
S Spleen
N Lymph nodes
H Liver
L Lung
M Bone marrow
O Bone
D Skin


  1. Cheson, Bruce D.; Fisher, Richard I.; Barrington, Sally F.; Cavalli, Franco; Schwartz, Lawrence H.; Zucca, Emanuele; Lister, T. Andrew; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin's Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute (2014-09-20). "Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification". Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 32 (27): 3059–3068. doi:10.1200/JCO.2013.54.8800. ISSN 1527-7755. PMID 25113753.
  2. Hodgkin lymphoma. Dr Amir Rezaee and Dr Frank Gaillard et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/lymphoma-staging
  3. Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/staging/?region=ab Accessed on September 11, 2015

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