Home » Hodgkin's Disease » Staging

Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Staging

Once the physician has diagnosed lymphoma, he or she will want to perform studies to establish the patient's stage—that is, to find out how far the patient's cancer has spread. Staging helps the physician to select appropriate treatment options and helps him/her to arrive at a prognosis, or estimate of disease outlook and survival. Clinical information is reviewed, including findings from the physical examination, blood tests, and imaging studies. The imaging studies most often employed are chest X-ray and computed tomographic (CT) scan of the chest, abdomen, and pelvis.

One of the hallmarks of HD is that it tends to spread from one lymph node set to the next, without "skipping" an area unless the disease has progressed very far. HD rarely invades single, nonlymphatic organs or sites, and it does not tend to spread to nearby organs. Because of these characteristics, HD is "staged" according to sites of involvement in relation to the diaphragm, the major muscle of the abdomen that is used for breathing.

If the patient has Hodgkin's Disease (HD), the physician may order additional tests such as a gallium scan and lymphangiography. In addition, a bone marrow biopsy may be obtained.

Tests
Gallium scanning—Gallium scanning is a nuclear medicine procedure. Radioactive gallium is injected into the patient's vein, and it is taken up by malignant lymphoma cells. A specialized camera then is used to produce a picture of the pooled gallium, which will identify the size and sites of cancerous areas. Gallium scanning is particularly useful when HD is located in the patient's chest; however, this procedure is used more often to help predict recurrence in patients with radiologic abnormalities that remain after therapy.

Lymphangiography—Lymphangiography is an X-ray technique that helps to reveal cancerous tissue in the lymphatic vessels after a special dye is injected into the lymphatic system. A lymphatic vessel in the foot often is chosen as an injection site if the physician suspects that HD has invaded the abdomen and pelvis.

Laparotomy—In most patients, clinical staging is all that is required to begin treatment planning. Yet, in some cases, the physician may request an exploratory laparotomy, surgery performed through an abdominal incision, for direct pathological staging. Laparotomy is a very invasive procedure—that is, it involves a large incision and many surgical instruments—but it is also the most accurate method for evaluating the spread of disease by direct observation and for biopsying small pieces of tissue. A pathologist will review such biopsies. The surgeon sometimes removes the spleen during laparotomy.

Laparotomy is performed much less often than it was a decade ago. Many specialists believe that laparotomy should be used as a staging procedure only if it alters therapy—in other words, if the physician is planning to administer chemotherapy or a combined treatment plan, there is no need to proceed with laparotomy.

Staging Systems
Several staging systems have been developed and revised for HD. Currently, the procedure most often used is the Cotswold System, also known as the modified Ann Arbor Staging System, which is divided into four categories. These categories are further subdivided by the designations A, B, and E, which refer to the absence of symptoms, presence of symptoms, and extension of disease into a nearby organ, respectively.

The Cotswold System for HD Staging

Stage I:	HD involves one lymph node group or structure (spleen, thymus) or HD extends locally to involve a single adjacent site (Stage I E).
Stage II:	HD involves two or more lymph node groups on the same side of the diaphragm or HD involves one or more lymph node groups on the same side of the diaphragm and there is localized involvement of the node(s) to one organ or site on the same side of the diaphragm (Stage II E).
Stage III:	HD involves lymph node groups on both sides of the diaphragm, or HD may have extended to an organ or site next to the lymph node(s) and/or spleen (Stage III E)
	III 1 - with/without involved nodes of the spleen, hilum, abdomen, or liver III 2 - with involved nodes of the aorta (large artery arising from the left heart), iliac (pelvic) artery, or mesenteric (intestinal) artery
Stage IV:	HD has spread through the bloodstream to one or more organs or sites outside of the lymphatic system, with/ without associated lymph node involvement.

© 1998-2008 Healthcommunities.com, Inc. All Rights Reserved.

Hodgkin's Disease Resources

	Questions to Ask Your Doctor About Your Cancer The more knowledge you have, the easier it is to make decisions about your cancer treatment. Print this free handout to take with you on your next office visit.	Advertising Disclaimer
	Join Our Hodgkin's Disease Forum Do you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience? The healthchannels forum is a resource for everyone to share and discuss their health and medical needs with others.
	Living with...Share your story Do you have a personal health story that you would like to share with others? As a source of free patient education, our goal is to provide our users with trustworthy information and support from others. That's why we've started our "Living with..." sections.
	Our "Living With..." support pages are a place to share experiences about living with a certain condition, disease, disorder, or illness and for loved ones of those dealing with health-related issues. Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Help others by sharing your story. View stories already submitted. In honor of National Cancer Survivors Day on June 1, 2008, we asked you to share your stories about surviving cancer. Read the inspiring stories we received or share your survival story and help others in the fight against cancer.
To quickly access health information from your website's browser, download Healthcommunities.com's healthchannels toolbar. Advertising Disclaimer