Ann Arbor staging
Ann Arbor staging is the staging system for lymphomas, both in Hodgkin's lymphoma and non-Hodgkin lymphoma. It was initially developed for Hodgkin's, but has some use in NHL. It has roughly the same function as TNM staging in solid tumors.
The stage depends on both the place where the malignant tissue is located and on systemic symptoms due to the lymphoma.
Principal stages
The principal stage is determined by location of the tumor:- Stage I indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
- Stage II indicates that the cancer is located in two separate regions, an affected lymph node or lymphatic organ and a second affected area, and that both affected areas are confined to one side of the diaphragm—that is, both are above the diaphragm, or both are below the diaphragm.
- Stage III indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
- Stage IV indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.
Modifiers
These letters can be appended to some stages:- A or B: the absence of constitutional symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage.
- S: is used if the disease has spread to the spleen.
- E: is used if the disease is "extranodal" or has spread from lymph nodes to adjacent tissue.
- X: is used if the largest deposit is >10 cm large, or whether the mediastinum is wider than one-third of the chest on a chest X-ray.
Type of staging
The nature of the staging is expressed with:- CS: clinical stage as obtained by doctor's examinations and tests.
- PS: pathological stage as obtained by exploratory laparotomy with splenectomy. Note: exploratory laparotomy has fallen out of favor for lymphoma staging.