en English

Staging of lymphoma

The stage of lymphoma looks at how much of your body is affected by lymphoma, and provides information on what the best types of treatment for you will be.

On this page:

What does staging mean?

Staging refers to how much of your body is affected by your lymphoma – or how far it has spread from where it first started.

Lymphocytes can travel to any part of your body. This means that lymphoma cells (the cancerous lymphocytes), can also travel to any part of your body. You will need to have more tests done to find this information. These tests are called staging tests and when you get results, you will find out if you have stage one (I), stage two (II), stage three (III) or stage four (IV) lymphoma.

Staging Lymphoma – The Ann Arbor or Lugano Staging System

Your stage of lymphoma will depend on:

  • How many areas of your body have lymphoma
  • Where the lymphoma is including if it is above, below or on both sides of your diaphragm (a large, dome-shaped muscle under your rib cage that separates your chest from your abdomen)
  • Whether the lymphoma has spread to your bone marrow or other organs such as your liver, lungs, skin or bone.

Stages I and II are called ‘early or limited stage’ (involving a limited area of your body).

Stages III and IV are called ‘advanced stage’ (more widespread). It’s important to know that unlike other cancers, many advanced stage aggressive lymphoma’s can be cured. Talk to you doctor about your chances of cure or long term remission.

Staging of lymphoma

Stage 1 and 2 lymphoma are considered early stage, and stage 3 and 4 are considered advanced stage lymphoma.
Stage 1

One lymph node area is affected, either above or below the diaphragm*.

Stage 2

Two or more lymph node areas are affected on the same side of the diaphragm*.

Stage 3

At least one lymph node area above and at least one lymph node area below the diaphragm* are affected.

Stage 4

Lymphoma is in multiple lymph nodes and has spread to other parts of the body (e.g. bones, lungs, liver).

Our diaphragm is a dome shaped muscle that runs along the bottom of our lungs and separates our chest from our abdomen. It also helps move our lungs up and down when we breathe.

Extra staging information

Your doctor may also talk about your stage using a letter, such as A,B, E, X or S. These letters give more information about the symptoms you have or how your body is being affected by the lymphoma. All this information helps your doctor find the best treatment plan for you. 


A or B

  • A = you have no B-symptoms
  • B  = you have B-symptoms
  • If you have B symptoms when you are diagnosed, you may have a more advanced-stage disease.
  • You may still be cured or go into remission, but you will need more intensive treatment

E & X

  • E = you have early stage (I or II) lymphoma with an organ outside of the lymph system – This might include your liver, lungs, skin, bladder or any other organ 
  • X = you have a large tumour that is larger than 10cm in size. This is also called “bulky disease”
  • If you have been diagnosed with limited stage lymphoma, but it is in one of your organs or is considered bulky, your doctor may change your stage to an advanced stage.
  • You may still be cured or go into remission, but you will need more intensive treatment


  • S = you have lymphoma in your spleen
  • You may need to have an operation to remove your spleen

(Our spleen is an organ in our lymphatic system that filters and cleans our blood, and is a place our B-cells rest and make antibodies)

Tests for staging

To find out what stage you have, you may be asked to have some of the following staging tests:

Computed tomography (CT) scan

These scans takes pictures of the inside of your chest, abdomen or pelvis. They provide detailed pictures that provide more information than a standard X-ray.

Positron emission tomography (PET) scan 

This is a scan that takes pictures of the inside of your whole body. You will be given and needle with some medicine that cancerous cells – such as lymphoma cells absorb. The medicine that helps the PET scan identify where the lymphoma is and the size and shape by highlighting areas with lymphoma cells. These areas are sometimes called “hot”.

Lumbar puncture

Central nervous system includes your brain and spinal cord. These are surrounded by a fluid called cerebral spinal fluidA lumbar puncture is a procedure done to check if you have any lymphoma in your central nervous system (CNS), which includes your brain, spinal cord and an area around your eyes. You will need to stay very still during the procedure, so babies and children may have a general anaesthetic to put them to sleep for a little while when the procedure is done. Most adults will only need a local anaesthetic for the procedure to numb the area.

Your doctor will put a needle into your back, and take out a little bit of fluid called “cerebral spinal fluid” (CSF) from around your spinal cord. CSF is a fluid that acts a bit like a shock absorber to your CNS. It also carries different proteins and infection fighting immune cells such as lymphocytes to protect your brain and spinal cord. CSF can also help drain any extra fluid you may have in your brain or around your spinal cord to prevent swelling in those areas.

The CSF sample will then be sent to pathology and checked for any signs of lymphoma.

Bone marrow biopsy
A bone marrow biopsy is done to check if there is any lymphoma in your blood or bone marrow. Your bone marrow is the spongey, middle part of your bones where your blood cells are made. There are two samples the doctor will take from this space including:
  • Bone marrow aspirate (BMA): this test takes a small amount of the liquid found in the bone marrow space.
  • Bone marrow aspirate trephine (BMAT): this test takes a small sample of the bone marrow tissue.
bone marrow biopsy to diagnose or stage lymphoma

A bone marrow biopsy can be done to help diagnose or stage lymphoma

The samples are then sent to pathology where they are checked for signs of lymphoma.

The process for bone marrow biopsies can differ depending on where you are having your treatment, but will usually include a local anaesthetic to numb the area.

In some hospitals, you may be given light sedation which helps you to relax and can stop you from remembering the procedure. However many people do not need this and may instead have a “green whistle” to suck on. This green whistle has a pain killing medication in it (called Penthrox or methoxyflurane), that you use as needed throughout the procedure.

Make sure you ask your doctor what is available to make you more comfortable during the procedure, and talk to them about what you think will be the best option for you.

More information on bone marrow biopsies can be found at our webpage here.

Staging of CLL - The RAI staging system

Swollen lymph node
Lymph nodes that become full of cancerous B-cells can become swollen with a visible lump.

Staging for CLL is slightly different than for other subtypes of lymphoma, because CLL starts in the blood and bone marrow.

The RAI staging system will look at your CLL to see if you do, or do not have any of the following:

  • high levels of lymphocytes in your blood or bone marrow – this is called lymphocytosis (lim-foe-cy-toe-sis)
  • swollen lymph nodes – lymphadenopathy (limf-a-den-op-ah-thee)
  • an enlarged spleen – splenomegaly (splen-oh-meg-ah-lee)
  • low levels of red blood cells in your blood – anaemia (a-nee-mee-yah)
  • low levels of platelets in your blood – thrombocytopenia (throm-bow-cy-toe-pee-nee-yah)
  • enlarged liver – hepatomegaly (hep-at-o-meg-a-lee)


What each RAI stage means

RAI stage 0Lymphocytosis and no enlargement of the lymph nodes, spleen, or liver, and with near normal red blood cell and platelet counts.
RAI stage 1Lymphocytosis plus enlarged lymph nodes. The spleen and liver are not enlarged and the red blood cell and platelet counts are normal or only slightly low.
RAI stage 2Lymphocytosis plus an enlarged spleen (and possibly an enlarged liver), with or without enlarged lymph nodes. The red blood cell and platelet counts are normal or only slightly low
RAI stage 3Lymphocytosis plus anaemia (too few red blood cells), with or without enlarged lymph nodes, spleen, or liver. Platelet counts are near normal.
RAI stage 4Lymphocytosis plus thrombocytopenia (too few platelets), with or without anaemia, enlarged lymph nodes, spleen, or liver.

*Lymphocytosis means too many lymphocytes in your blood or bone marrow

Clinical Grading of Lymphoma

Your lymphoma cells have a different growth pattern, and look different to normal cells.  The grade of your lymphoma is how quickly your lymphoma cells are growing, which affects the way look under a microscope. The grades are Grades 1-4 (low, intermediate, high).  If you have a higher grade lymphoma, your lymphoma cells will look the most different from normal cells, because they are growing too quickly to develop properly. An overview of the grades is below.

  • G1 – low grade – your cells look close to normal, and they grow and spread slowly.  
  • G2 – intermediate grade – your cells are starting to look different but some normal cells exist, and they grow and spread at a moderate rate.
  • G3 – high grade – your cells look fairly different with  a few normal cells, and they grow and spread faster. 
  • G4 – high grade – your cells look most different to normal, and they grow and spread the fastest.

All this information adds to the whole picture your doctor builds to help decide the best type of the treatment for you. 

It is important that you talk to your doctor about your own risk factors so you can have clear idea of what to expect from your treatments.

For more info click the below links

For more info see
What is lymphoma
For more info see
Understanding your lymphatic and immune systems
For more info see
Causes & Risk Factors
For more info see
Symptoms of Lymphoma
For more info see
Treatments for lymphoma & CLL
For more info see
Definitions - Lymphoma dictionary

Support and information

Sign up to newsletter

Share This

Newsletter Sign Up

Contact Lymphoma Australia Today!

Please note: Lymphoma Australia staff are only able to reply to emails sent in English language.

For people living in Australia, we can offer a phone translation service. Have your nurse or English speaking relative call us to arrange this.