Clinical staging protocol:
(1) complete history and physical
(2) chest roentgenography
(3) appropriate scans (bone, CT, MRI)
(4) blood and urine analysis
(5) bilateral bone marrow biopsies
(6) tissue biopsies, including staging laparotomy when indicated
(7) symptom driven: GI tract, CNS
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Stage
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Substage
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Features
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I
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involvement of a single lymph node region
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I(E)
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localized involvement of a single extralymphatic organ or site
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II
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involvement of 2 or more lymph node regions on the same side of the diaphragm
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II(E)
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localized involvement of a single associated extralymphatic organ or site and its regional lymph nodes with or without other lymph node regions on the same side of the diaphragm
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III
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involvement of lymph node regions on both sides of the diaphragm
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III(E)
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involvement of lymph node regions on both sides of the diaphragm accompanied by localized involvement of an extralymphatic organ or site
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III(S)
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involvement of lymph node regions on both sides of the diaphragm accompanied by involvement of the spleen
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III(E+S)
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involvement of lymph node regions on both sides of the diaphragm accompanied by both localized involvement of an extralymphatic organ or site and the spleen
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IV
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disseminated (multifocal) involvement of one or more extralymphatic organs with or without associated lymph node involvement
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isolated extralymphatic organ involvement with distant (nonregional) nodal involvement
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where:
• The letters in parentheses are subscripts.
• The spleen is taken as a nodal site (Coiffier et al, 1989).
Clinical Categories
The presence or absence of systemic symptoms attributable solely to the lymphoma has prognostic significance and can be used to subdivide each stage.
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Category
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Features
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A
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absence of B symptoms
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B
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unexplained loss of more than 10% of body weight in the 6 months before diagnosis
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unexplained fever with temperatures above 38°C
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drenching night sweats
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pruritis that is recurrent, generalized and otherwise unexplained and which ebbs and flows parallel to disease activity
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