Disease staging If all information gained from the above mentioned examination techniques is available, the spread of the lymphoma throughout the body can be determined and classified. The classification follows the Ann-Arbor staging system. Ann Arbor classification (lymphoma spread) | Stage I | Nodal involvement in a single region
or
a single localized extranodal involvement (outside the lymphatic system | | Stage II | Nodal involvement in two or more regions on one side of the diaphragm
and/or
localized extranodal involvements (outside the lymphatic system) in two or more regions on one side of the diaphragm | | Stage III | Nodal involvement and/or localized extranodal involvements (outside the lymphatic system) on both sides of the diaphragm | | Stage IV | Not localized, diffuse and disseminated involvement of one or more extralymphatic organs with or without involvement of lymphatic tissue | | Suffix A | No detectable B-symptoms | | Suffix B | B-symptoms (fever > 38°C and/or night sweats and/or weight loss, see above) are present | The lymphatic system includes the lymph nodes, spleen, thymus, Waldyer’s ring, appendix and Peyer’s patches. Beside the histology and the dissemination of the lymphoma, some other defined risk factors are relevant for disease staging in the trials of the German Hodgkin Study Group (GHSG). These risk factors are:
- Presence of a large mediastinal mass, measured by means of a chest X ray image; the mediastinal mass is considered as large if it measures at least one third of the transverse diameter of the thorax.
- Extranodal disease, i.e. any tumor spread that involves other tissue than that of the lymph nodes, spleen, thymus, Waldyer’s ring, appendix and Peyer’s patches.
- High erythrocyte sedimentation rate (ESR), (50mm/h if A symptoms are present, 30mm/h if B symptoms are present)
- Three or more lymph node areas are involved (lymph node areas do not correspond to the lymph node regions according to the Ann Arbor classification; a lymph node area may include several lymph node regions)
The GHSG definition of risk groups On the basis of the above mentioned criteria, the GHSG subdivides Hodgkin lymphoma patients into the following risk groups: Early stages - Stage IA or IB and IIA or IIB according to the Ann Arbor classification without risk factors
Intermediate stages - Stage IA or IB and stage IIA with one or more risk factors
- Stage IIB, only if the risk factors ‘high ESR’ and/or ‘involvement of > 3 lymph node areas’ are present
Advanced stages
Treatment is chosen accordingly, i.e. it is adapted to the disease stage.
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Hodgkin Lymphoma 
