The staging system for non-Hodgkin’s lymphoma (NHL) consists of four categories. Depending on how far the cancer has spread, the disease will be placed in either stage I, II, III or IV. The letter “E” is added to the stage when an organ outside of the lymph system is affected. 

Stage I. Non-Hodgkin’s lymphoma is considered to be at stage I when one of the following factors is present:

• The cancer is found in only one lymph node area such as the neck, armpit or groin.
  
  
• The cancer is found in only one area of a single organ outside of the lymph system (IE).

Stage II. NHL is considered to be at stage II when one of the following factors is present:

• The cancer is found in two or more lymph node areas on the same side (above or below) of the diaphragm (a muscle that separates the chest and abdominal cavities, and aids breathing).
  
  
• The cancer has spread locally from the lymph nodes into nearby tissue (IIE).

Stage III. NHL is considered to be at stage III when one of the following factors is present:

• The cancer is found in lymph node areas on both sides (above and below) of the diaphragm.
  
  
• The cancer may have spread into an organ or area next to the lymph node (IIIE), into the spleen (IIIS), or both (IIISE).

Stage IV. NHL is considered to be at stage IV when one of the following factors is present:

• The cancer has extended to more than one area in an organ or to two or more organs outside of the lymph system.
  
  
• The cancer has extended to only one organ outside of the lymph system, but lymph nodes far from the organ are involved.
  
  
• The cancer has extended to the brain, spinal cord, liver or bone marrow.

These stages may be further separated into “A” (symptoms are not present) and “B” (certain symptoms are present) categories. A patient is placed in the “B” category when the following symptoms are present:

• A loss of more than 10 percent of total body weight over the previous six months
  
  
• A fever at or above 100 degrees Fahrenheit (38 degrees Celsius) without a known cause (except the cancer)
  
  
• Drenching night sweats

The international prognostic index (IPI) was developed to aid physicians in predicting how quickly a patient’s lymphoma would grow, whether treatment is needed, and how well a patient would react to treatment. This information is important to physicians who are planning treatment. The index also provides patients with information about the outlook for their disease.

The index is based on five factors:

• Age
  
  
• Stage of the disease
  
  
• Whether or not organs outside of the lymph system are affected
  
  
• Performance status (how well a patient can perform normal daily activities)
  
  
• Level of lactate dehydrogenase (LDH) in the blood serum

The factors are then divided into either good prognostic factors or poor prognostic factors.

For each poor prognostic factor that a patient has, they are given one point. More than 75 percent of the people with no points or one point live longer than five years, regardless of the type of lymphoma. In contrast, only 30 percent of those with most or all unfavorable factors live longer than five years.