n WHAT IS METASTASIS? Metastasis refers to the spread of a tumor from its original location (i.e., primary site) to other parts of the body. Hodgkin lymphoma often spreads from one lymph node to another and also can spread to organs outside the lymphatic system. If a biopsy reveals Hodgkin lymphoma, additional tests will be performed to find out if the cancer has spread to other parts of the body. n WHAT IS STAGING? Staging is the process of determining the location and extent of a disease at the time of diagnosis. The information gathered from the staging process determines the extent of the involvement of the disease and helps guide treatment for that disease. There are four stages in Hodgkin lymphoma which are determined by the locations of the lymph node chains that have tumors. A higher stage number indicates that the disease has spread further throughout the body. Hodgkin Lymphoma Staging Within each stage, the letters "E" and "S" are used to further classify the disease. "E" indicates that cancer has extended into an organ or tissue that is not part of the lymphatic system but is next to an involved lymph node. "S" indicates that cancer is found in the spleen. STAGE I • Stage I: Cancer is found in one group of lymph nodes. • Stage IE: Cancer is found in one group of lymph nodes and has extended to a nearby organ or tissue that is not part of the lymphatic system. STAGE II • Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm (the breathing muscle that separates the chest and belly areas). • Stage IIE: Cancer is found in two or more lymph-node groups on the same side of the diaphragm and has extended from one of those lymph nodes to a nearby organ or tissue that is not part of the lymphatic system. STAGE III • Stage III: Cancer is found on both sides of the diaphragm. • Stage IIIE: Cancer is found on both sides of the diaphragm and has extended from one of these lymph nodes to a nearby organ or tissue that is not part of the lymphatic system. • Stage IIIS: Cancer is found on both sides of the diaphragm and in the spleen. • Stage IIIE+S: Cancer is found on both sides of the diaphragm and in the spleen and has extended from one of these lymph-node groups to a nearby organ or tissue that is not part of the lymphatic system. STAGE IV • Stage IV: Cancer is found throughout one or more organs that are not part of the lymphatic system (e.g., the lungs, bones, or bone marrow) and may be in lymph nodes that are near or far from those organs. Each stage is further classified as either "A" or "B." "A" means the child has no specific symptoms. "B" indicates the child has experienced specific symptoms prior to diagnosis. These specific "B" symptoms include an unexplained fever that exceeds 100.4 ºF/38.0 ºC, drenching night sweats, or weight loss of at least 10% of the individual’s body weight during a 6-month period.
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