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Definition of Stages 

The staging system for Hodgkin lymphoma used at BCCA is based on clinical staging according to the Ann Arbor system with the additions of a definition of bulky disease. Staging laparotomy is not required.

Stage     Involvement
1Single lymph node region (1) or one extralymphatic site (1E).
2Two or more lymph node regions, same side of the diaphragm (2) or local extralymphatic extension plus one or more lymph node regions same side of the diaphragm (2E).
3Lymph node regions on both sides of the diaphragm (3) which may be accompanied by local extralymphatic extension (3E).
4Diffuse involvement of one or more extralymphatic organs or sites.


A   =  no B symptoms
B  = presence of at least one of these
1) unexplained weight loss > 10% baseline during 6 months prior to staging
2)recurrent unexplained fever > 38oC
3)recurrent night sweats

Bulky tumour is defined as a single mass of tumour tissue 10 cm or larger in largest diameter.

Mandatory Staging Procedures

  1. Pathology review           
  2. All patients should receive the immunizations recommended in Appendix III           
  3. Complete history and physical examination including rectal and gynecological examinations           
  4. Complete blood count.            
  5. Serum creatinine, alkaline phosphatase, lactate dehydrogenase, bilirubin, calcium, AST, albumin (usually most easily obtained by ordering a serum protein electrophoresis)           
  6. Chest radiograph, PA and lateral views           
  7. CT scan of neck, thorax, abdomen and pelvis
  8. PET/CT scan
  9. Hepatitis B surface antigen (HBsAg), hepatitis Bcore antibody, hepatitis C antibody

Certain tests are required only in special circumstances.

Test Presentation/Condition
Bone marrow biopsy and  aspirationB symptoms or
WBC < 4.0 x 109/L or
Hgb < 120 g/L (women), 130 g/L (men) or
Platelets < 125 x 109/L
ENT examinationStage 1A or 2A disease with upper cervical lymph node involvement (supra-hyoid)

Assessment of the Liver

Only well defined non-cystic space-occupying lesions documented by CT scan or sonogram can be accepted as unequivocal evidence of liver involvement. Abnormal liver function tests with or without hepatomegaly are not firm evidence of liver involvement.

Assessment of the Spleen 

Patients with sonographic or CT scan evidence of discrete non-cystic lesions in the spleen are considered to have extensive splenic involvement for treatment planning. Patients with minimal enlargement of the spleen (enlarged by scan but not palpable or only the tip palpable) are not considered to have splenic involvement.

SOURCE: Staging ( )
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