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|
|1||Single lymph node region (1) or one extralymphatic site (1E).|
|2||Two 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).|
|3||Lymph node regions on both sides of the diaphragm (3) which may be accompanied by local extralymphatic extension (3E).|
|4||Diffuse 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
- Pathology review
- All patients should receive the immunizations recommended in Appendix III
- Complete history and physical examination including rectal and gynecological examinations
- Complete blood count.
- Serum creatinine, alkaline phosphatase, lactate dehydrogenase, bilirubin, calcium, AST, albumin (usually most easily obtained by ordering a serum protein electrophoresis)
- Chest radiograph, PA and lateral views
- CT scan of neck, thorax, abdomen and pelvis
- PET/CT scan
- Hepatitis B surface antigen (HBsAg), hepatitis Bcore antibody, hepatitis C antibody
Certain tests are required only in special circumstances.
|Bone marrow biopsy and aspiration||B 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 examination||Stage 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.