Key Points for This Section

After childhood 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. There are three ways that cancer spreads in the body. The letters "E" and "S" may be used to describe the stages of childhood Hodgkin lymphoma. The following stages are used for childhood Hodgkin lymphoma: Stage I Stage II Stage III Stage IV Untreated, classical Hodgkin lymphoma is divided into risk groups. Childhood Hodgkin lymphoma is staged again after initial chemotherapy.

After childhood 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. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:

• 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). An MRI of the abdomen and pelvis may be done.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• 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 abnormal cells.

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  Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.

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 letters "E" and "S" may be used to describe the stages of childhood Hodgkin lymphoma.

• E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.
• S: Cancer is found in the spleen.

The following stages are used for childhood Hodgkin lymphoma:

Stage I

Stage I is divided into stage I and stage IE.

• Stage I: Cancer is found in one group of lymph nodes.
• Stage IE: Cancer is found in one group of lymph nodes and has spread to a nearby organ or tissue that is not part of the lymph system.

Stage II

Stage II is divided into stage II and stage IIE.

• Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm.
• Stage IIE: Cancer is found in two or more lymph node groups on the same side of the diaphragm and has spread from one of those lymph nodes to a nearby organ or tissue that is not part of the lymph system.

Stage III

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIE+S.

• Stage III: Cancer is found in lymph node groups on both sides of the diaphragm.
• Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and has spread from one of these lymph nodes to a nearby organ or tissue that is not part of the lymph system.
• Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.
• Stage IIIE+S: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen, and has spread from one of these lymph node groups to a nearby organ or tissue that is not part of the lymph system.

Stage IV

In stage IV, cancer is found throughout one or more organs that are not part of the lymph system and may be in lymph nodes that are near or far away from those organs.

Untreated, classical Hodgkin lymphoma is divided into risk groups.

Untreated, classical childhood Hodgkin lymphoma is divided into risk groups based on the bulk of the tumor (tumors that are 5 centimeters or larger are considered "bulky") and whether the patient has "b" symptoms (fever, weight loss, or night sweats). Treatment is based on the risk group.

• Low-risk disease:
  • Patients with stage I or stage II disease; and
  • No bulky tumors or "b" symptoms.
• Intermediate-risk disease:
  • Patients with stage I or stage II disease, with bulky tumors, or with "b" symptoms; or
  • Patients with stage III or stage IV disease without "b" symptoms.
• High-risk disease: Patients with stage III or stage IV disease with "b" symptoms.

Childhood Hodgkin lymphoma is staged again after initial chemotherapy.

A PET or gallium scan is done after chemotherapy ends to find out how well the chemotherapy worked.

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