Lymphoma Staging

Lymphoid neoplasms


Ann Arbor Staging for HD and NHL

I One LN region or extralymphatic site (IE)
II ≥ 2 LN regions or 1 extranodal site with associated LN region(s)
III Involvement of both sides of the diaphragm
IV BM, Lung, liver or diffuse/disseminated extra-LN site involvement


  • X Bulky disease
  • A No B symptoms
  • B Fever > 38oC, night sweats, or weight loss >10% body weight over previous 6 months
  • E Involvement of extranodal site
  • # Number of Involved Regions
  • CS: clinical stage, PS: pathologic stage
  • Regions include: Waldeyer’s ring, Supraclavicular/cervical/occipital/preauricular, axillary, infraclavicular, mediastinal, hilar, epitrochlear/brachial, paraaortic, mesenteric, iliac, spleen, inguinal/femoral, popliteal.

Extranodal sites

  • S: Spleen
  • L: Lung
  • M: Bone marrow
  • Pard: Pericardium
  • P: Pleura
  • W: Waldeyer's
  • O: Osseous
  • GI: Gastrointestinal
  • D: Skin
  • Softis: Soft tissue
  • Thy: Thyroid

Core Nodal Regions (AJCC 6th Ed.)

  • Cervical (includes cervi al, supraclavicular, occipital, and preauricular LN)
  • axillary
  • infraclavicular
  • mediastinal
  • hilar
  • para-aortic
  • mesenteric
  • pelvic
  • inguinofemoral

Unfavorable Factors (Localized presentations)

  • Bulky disease
    • Mediastinal mass (chest x-ray): maximum mass width/ maximum intrathoracic diameter > 1/3.
    • Mediastinal mass greater than 35% of the thoracic diameter at T5-6
    • Anyother mass > 10 cm on CT

(Only bulky disease is incorporated into NCCN algorithm)

  • Erythrocyte sedimentation rate ≥ 50, if asymptomatic
  • > 3 sites involved
  • B symptoms
  • Extranodal sites

Waldeyer's Ring

  • "guard" openings into respiratory and digestive systms
  • caudally, the lingual tonsil on root of tongue
    • posterior to the sulcus terminalis is the pharyngeal part of the tongue. mucous membrane of this part has no papillae;
    • however, the underlying nodules of lymphoid tissue give this part cobblestone appearance.
    • These lymphoid nodules are called lingual tonsil.
  • laterally: the palatine and tubal tonsils
  • dorsally: the pharyngeal tonsil (adenoid)
    • adenoids are located on both sides of the nasopharynx, medial to the eustachian tube orifices.

Patients with lymphoma involving the mediastium, spleen, and para-aortic nodes and B-symptoms will be stage III2BS.

Multiple Myeloma

Stage Durie-Salmon Criteria ISS Criteria
I All of the following:
Hemoglobin value >10 g/dL
Serum calcium value normal or ≤12 mg/dL
Bone x-ray, normal bone structure (scale 0) or solitary bone plasmacytoma only
Low M-component production rate
— IgG value <5 g/dL; IgA value <3 g/dL
Bence Jones protein <4 g/24 h
ß2-M <3.5 and Albumin ≥3.5
II Neither stage I nor stage III
III On or more of the following:
Hemoglobin value <8.5 g/dL
Serum calcium value >12 mg/dL
Advanced lytic bone lesions (scale 3)
High M-component production rate
— IgG value >7 g/dL; IgA value >5 g/dL
Bence Jones protein >12 g/24 h
ß2-M >5.5

Durie-Salmon sub classifications (either A or B)
A: Relatively normal renal function (serum creatinine value <2.0 mg/dL
B: Abnormal renal function (serum creatinine value ≥2.0 mg/dL

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