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Making sense of the stages of Hodgkin lymphoma

Most cancers are staged as I, II, III or IV. The lower the number, the less likely that the cancer has spread. There are several tests that help show what stage a person’s Hodgkin lymphoma is in—or how far a cancer has spread.

Tests to help know the stages

Hodgkin lymphoma is a cancer of the lymph system. You have lymph nodes throughout your body, so Hodgkin lymphoma can start or spread anywhere in your body. The only way to tell for sure if a person has Hodgkin lymphoma is to do a biopsy of one or more of the swollen lymph nodes. This means that a lymph node is taken out and looked at under a microscope to check for cancer cells. A biopsy is usually done in the hospital with local anesthesia. This means the area around the node is numbed. Sometimes medication is given to make the person sleepy during the biopsy.

A chest X-ray is done to see if there are swollen lymph nodes anywhere in the chest. Often, the doctor will order one or more scans. These may include a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or a positron emission tomography (PET) scan. If the doctor thinks the lymphoma may have spread to the bone marrow, you might need a bone marrow biopsy.

When the test results come back, the doctor can tell if the cancer has spread and how far it may have spread. The doctor will then know what stage the cancer is in and suggest the treatment that is best for you.

The four stages

Stage I: Hodgkin lymphoma cells are found in just one lymph node, in a small group of lymph nodes very close to each other, or outside the lymph node but still close by.

Stage II: Hodgkin lymphoma cells are seen in two or more lymph nodes or small groups of lymph nodes – but all are on the same side of the diaphragm. (The diaphragm is the muscle between your chest and your belly that helps you breathe in and out.) Sometimes in stage 2, cancer cells may be found outside the lymph nodes, but still on the same side.

Stage III: Hodgkin lymphoma cells are found on both sides of the diaphragm.

Stage IV: Hodgkin lymphoma cells have spread through more parts of the body, including to organs like your lungs or liver.

Sometimes the letter A or B is added to the stage number. For example, the cancer may be labeled Stage IIA or Stage IIIB. “A” means that you don’t have other symptoms of cancer. “B” means that besides swollen lymph nodes, you also have other cancer symptoms like fever and chills that come and go, losing weight without trying, tiredness (fatigue) or night sweats.

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Your CVS Specialty® CareTeam is always available to answer your questions. They can also help with medication side effects and provide you with the information  to help you learn more about your condition. If you have questions, talk to your doctor or contact the CareTeam.

CT – computerized tomography
MRI – magnetic resonance imaging
PET – positron emission tomography

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