Non-Hodgkin Lymphoma Staging

If you have been diagnosed with non-hodgkin lymphoma, the next step will be to figure out if it has spread, and if so, how far. Your doctor will do this through a process called staging. The information gathered from the staging process determines the stage of the disease, which assists your doctor in understanding the seriousness of your cancer, providing an optimal treatment plan, identifying potential clinical trials for viable treatment options, and even providing chances of survival (prognosis).

Non-Hodgkin Lymphoma Test for Staging

Staging may involve one or more of the following tests:

Bone marrow biopsy

During this procedure, your doctor uses a thick needle to remove a small sample of bone and bone marrow from your hip bone or another large bone (local anesthesia can help control pain). After the sample is taken, a pathologist looks for lymphoma cells under a microscope.

CT Scan

This type of scan takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. To make it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray, you may receive an injection of contrast material and/or be asked to drink another type of contrast material.


MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film. Your doctor may order MRI pictures of your spinal cord, bone marrow, or brain.


 An ultrasound device sends out sound waves that you cannot hear. During the test, a small hand-held device is held against your body. The waves bounce off nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show possible tumors.

Spinal Tap

During a spinal tap, the doctor uses a long, thin needle to remove fluid from the spinal column, after administering local anesthesia. You must lie flat for a few hours afterward so that you don’t get a headache. The lab checks the fluid for lymphoma cells or other problems.

PET Scan

This test involves receiving an injection of a small amount of radioactive sugar. A machine then makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter in the pictures.

Over the years, there have been many different systems used for staging lymphomas. The current staging system, however, is known as the Lugano classification, which is based on the older Ann Arbor system. The stages are described by Roman numerals I through IV (1-4). 

Non-Hodgkin Lymphoma Stages

The stages of non-hodgkin lymphoma are as follows:

Stage I

The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).

Stage II

The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III

The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

Stage IV

Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.


The disease returns after treatment.

Additional Staging Factors for Non-Hodgkin Lymphoma 

In addition to these stage numbers, your doctor may also describe the stage as A,B, E, or S:

  • A: You have not had weight loss, drenching night sweats, or fevers.
  • B: You have had weight loss, drenching night sweats, or fevers.
  • E: Indicates the disease affects tissues or organs outside the lymphatic system. 
  • S: Used if the disease has spread to the spleen.

At Rocky Mountain Cancer Centers, we understand that a lymphoma diagnosis can be scary and overwhelming, which is why our expert oncologists are committed to providing you peace of mind by offering the most advanced treatments for all types of cancers of the blood, including lymphomas. Please find the Rocky Mountain Cancer Centers location that is most convenient for you and call to request an appointment.

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For some patients, especially those with an aggressive subtype of NHL, treatments may have already started. For patients with a slower growing lymphoma, the treatment planning process may start after staging is complete.