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Classifying and Staging Lymphoma

Video : Staging Your Lymphoma - Chapter 4 - Living With Lymphoma

Classifying Lymphoma

The doctor needs to identify the exact type (classification) of Lymphoma you have to help determine the most appropriate treatment for you. The biopsy procedure is critical in the classification process as it provides cells taken directly from the tumour. This allows doctors to determine which type of cell the tumour originated from (B-cell or T-cell), as well as other important information about the tumour cells. The biopsy is often called a a “tissue diagnosis (meaning the diagnosis is made through an examination of the tissue or cells) and the course of the patients treatment depends on these results.
nce the surgeon has performed the biopsy and the pathologist has examined the tissue and tumour cells, the information is used to confirm the exact type of Lymphoma you have. The classification process is a complicated one and many organisations have attempted to simplify this. However, the most commonly used system is the World Health Organization (WHO) Lymphoma Classification System which allows different Lymphoma types to be classified in a standardised way amongst doctors around the world. Once the type, or classification, has been identified, it is then important to determine the stage and grade of the Lymphoma.

Clinical Grading of Lymphoma

The doctor must also determine the grade of the tumour, which provides information on how aggressive (fast-growing) the tumour is and helps predict how the tumour will behave. This information then helps to decide the aggressiveness of the treatment approach.

The grade is determined by the appearance of the cancer cells, what unique characteristics they have, how they function and how quickly they grow and divide.

The following table summarises the specialised process of classifying, staging and grading Lymphoma:

Description

What It Describes

Classification

 Lymphoma type

Stage

 Extent of spread

Grade

 Aggressiveness:
  • Indolent = low-grade; slow growing
  • Aggressive = intermediate- and high-grade; fast growing

Staging Lymphoma 
The stage of a cancer provides information on the extent to which the cancer has spread within the body. There are four stages of Lymphoma, with stages 1 and 2 being limited (involving a limited area of the body) and stages 3 and 4 being advanced (more widespread). The stage is determined by:

  • The number and location of lymph nodes affected;
  • Whether the affected lymph nodes are above, below or on both sides of the diaphragm (the large, dome-shaped muscle under the ribcage that separates the chest from the abdomen);
  • Whether the disease has spread to the bone marrow or to other organs such as the liver

The most common method for staging Lymphoma is called the Ann Arbor Staging System, which can be summarised as follows:

Stage What It Means
1 Is in only one group of lymph nodes
2 Two or more groups of lymph nodes are affected but they are all either above or below the diaphragm, either all in the chest or all in the abdomen
3 Two or more groups of lymph nodes are affected in both the chest and the abdomen
4 Lymphoma is in at least one organ (e.g. bone marrow, liver or lungs) as well as the lymph nodes

 

Each stage of Lymphoma may also be classified as A or B. Patients with a B classification status have one or more of the following 
“B symptoms":
  • unexplained weight loss of more than 10% in the six months before diagnosis
  • Unexplained fever with temperatures above 38°C
  • Drenching night sweats.

The presence of B symptoms may be associated with more advanced-stage disease.