Hodgkins Disease (cont.)
Your doctor needs to know the extent (stage) of Hodgkin lymphoma to plan the
best treatment. Staging is a careful attempt to find out what parts of the body
are affected by the disease.
Hodgkin lymphoma tends to spread from one group of lymph nodes to the next
group. For example, Hodgkin lymphoma that starts in the lymph nodes in the neck
may spread first to the lymph nodes above the collarbones, and then to the lymph
nodes under the arms and within the chest.
In time, the Hodgkin lymphoma cells can invade blood vessels and spread to
almost any other part of the body. For example, it can spread to the liver,
lungs, bone, and bone marrow.
Staging may involve one or more of the following tests:
- CT scan: An x-ray machine linked to a computer takes a series of
detailed pictures of your chest, abdomen, and pelvis. You may receive an
injection of contrast material. Also, you may be asked to drink another type
of contrast material. The contrast material makes it easier for the doctor
to see swollen lymph nodes and other abnormal areas on the x-ray.
- MRI: A powerful magnet linked to a computer is used to make
detailed pictures of your bones, brain, or other tissues. Your doctor can
view these pictures on a monitor and can print them on film.
- PET scan: You receive an injection of a small amount of
radioactive sugar. A machine 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 on the pictures.
- Bone marrow biopsy: The doctor uses a thick needle to remove a
small sample of bone and bone marrow from your hipbone or another large
bone. Local anesthesia can help control pain. A pathologist looks for
Hodgkin lymphoma cells in the sample.
Other staging procedures may include biopsies of other lymph nodes, the
liver, or other tissue.
The doctor considers the following to determine the stage of Hodgkin
- The number of lymph nodes that have Hodgkin lymphoma cells
- Whether these lymph nodes are on one or both sides of the diaphragm (see
- Whether the disease has spread to the bone marrow, spleen, liver, or
The stages of 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 lymphoma cells are not in the lymph nodes,
they are in only one part of a tissue or an organ (such as the lung).
- 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 a tissue or 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 cells are in lymph nodes above and below the
diaphragm. Lymphoma also may be found in one part of a tissue or an organ
(such as the liver, lung, or bone) near these lymph node groups. It may also
be found in the spleen.
- Stage IV: Lymphoma cells are found in several parts of one or more
organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung,
or bone) and in distant lymph nodes.
- Recurrent: The disease returns after treatment.
In addition to these stage numbers, your doctor may also describe the stage
as A or B:
- A: You have not had weight loss, drenching night sweats, or fevers.
- B: You have had weight loss, drenching night sweats, or fevers.
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