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Stages of Childhood Non-Hodgkin Lymphoma
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After childhood non-Hodgkin lymphoma has been diagnosed,
tests are done to find out if cancer cells have spread within the lymph system
or to other parts of the body.
The process used to find out if cancer has spread within the lymph system or to other parts of
the body is called staging. The
information gathered from the staging process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
Some of the tests that are used to diagnose childhood non-Hodgkin lymphoma are also used to stage the disease. The following tests and procedures may be used in the staging process:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
| Enlarge | | | | Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions. |
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
- Gallium scan: A procedure to detect areas of the body where cells, such as cancer cells, are dividing rapidly. A very small amount of radioactive material, gallium, is injected into a vein and travels through the bloodstream. The gallium collects in the bones or other tissues (organs) and is detected by a scanner.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
- Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
| Enlarge | | | | Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing. |
- Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for childhood non-Hodgkin
lymphoma:
Stage I
In stage I childhood
non-Hodgkin lymphoma, cancer is found in a single area or lymph node outside of the abdomen or chest.
Stage II
In stage II childhood non-Hodgkin
lymphoma, cancer is found:
- in only one area and in the lymph nodes around it; or
- in 2 or more areas or lymph nodes
on one side of the diaphragm (the thin muscle under the lungs that divides the chest and abdominal cavity and helps
with breathing); or
- to have started in the stomach or intestines and has been completely removed by surgery, and lymph nodes in the area may or may not have cancer.
Stage III
In stage III
childhood non-Hodgkin lymphoma, cancer is found:
- in areas or lymph nodes on both sides of
the diaphragm; or
- to have started in the chest; or
- in more than one place in the abdomen; or
- in the area around the spine.
Stage IV
In stage IV childhood
non-Hodgkin lymphoma, cancer is found in the bone marrow, brain, or spinal cord. Cancer may also be found in other parts of the body.
Childhood non-Hodgkin lymphoma is also described as localized or disseminated.
Treatment for childhood non-Hodgkin lymphoma is based on whether the cancer is localized or disseminated. Localized lymphoma has not spread beyond the area in which it began. Disseminated lymphoma has spread beyond the area in which it began. Stage I and stage II are usually considered localized. Stage III and stage IV are usually considered disseminated.
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