What Are Grading And Staging?

When a doctor has found cancer cells and is sure that they are from a lymphoma, it is important to know the grade and the stage of the cancer. Lymphomas of different grades and stages grow at different rates, and respond differently to treatment.

• The grade of a lymphoma refers to how quickly, or aggressively, it is growing.

• The stage of lymphoma or any cancer depends on how far it has spread throughout the body.

• Grade and stage are the most important factors for predicting how a patient will do and for deciding on the best treatment.

Grade

For non-Hodgkin's lymphoma, grade is the most important factor in predicting the likely outcome with and without treatment. Lymphomas are usually divided into three main grade categories:

• Low-grade or indolent: slow-growing lymphomas that can go for many years without treatment.

• Intermediate-grade or aggressive: faster-growing lymphomas.

• High-grade or highly aggressive: very fast-growing lymphomas.

Stage

In order to decide on the best treatment, it is helpful to know what stage the cancer has reached. The stage describes how far it has spread through the body from where it began. Lymphomas are grouped into four stages, from Stage I to Stage IV. Stage IV is the most serious.

The stage and whether the cancer has spread or remains as a single tumor is more important for slow-growing, low-grade lymphomas than for the more aggressive high-grade tumors.

To find out what stage a lymphoma has reached, the doctor will want to find out:

• How many lymph nodes contain cancer cells and where are they located.

• Whether these lymph nodes are above, below, or on both sides of the diaphragm.

• Whether the disease spread to the bone marrow, the spleen, or to other organs outside the lymphatic system.

To find out the stage of a lymphoma, a doctor will usually do several new tests and repeat ones that were done to diagnose the lymphoma. These may include:

• A bone marrow biopsy to show whether the cancer has spread into the bone marrow. To do a bone marrow biopsy, a doctor removes a sample of bone marrow through a needle inserted into the hip or another large bone.

• A CT scan or lymphangiogram.

• Taking samples from other tissues, such as the liver or stomach, to see whether tumor cells are present.

• Sometimes, a doctor may want to do an operation called a laparotomy to look for additional tumors. During a laparotomy, a surgeon takes samples of tissue from inside the abdomen. If a CT scan can be done, a laparotomy is usually not necessary. Results from a CT scan are usually considered more accurate.

• Depending on where cancer cells or tumors are found, other tissue samples and tests may need to be done.

The four stages of lymphoma are:

• Stage I: A single tumor which hasn't spread.

• Stage II: More than one tumor, but the tumors are all found in lymph nodes on the same side of the diaphragm (all above or all below). Stage II can also mean that a tumor has spread to another organ, but that it is close to the original lymph node tumor.

• Stage III: More than one tumor with the tumors found on different sides (above and below) of the diaphragm. There may be tumors in the spleen or more than one tumor in nearby organs.

• Stage IV: Many tumors spread throughout an organ such as the liver or stomach, as well as in the lymph nodes. Stage IV can also refer to a single tumor in another organ, plus tumors in distant lymph nodes.