Stage Group Lymphoma (p)

This input is used for staging

Notes

**Note 1:** Pathologic stage follows clinical stage with clinical information supplemented by the information obtained from staging laparotomy and splenectomy. Since the current approach to treatment almost always includes systemic treatment, staging laparotomy is no longer performed and pathologic staging is usually not available. (1) * Staging laparotomies include: laparotomy/laparoscopy, splenectomy, liver, lymph node & bone marrow biopsies. All of these must be done to qualify as a staging laparotomy * If a staging laparotomy is not performed, pathologic stage group is coded as 99 **Note 2:** The lymphatic structures are as follows * Lymph nodes (C770-C779) * Waldeyer's ring (tonsils) (C024, C090-C099, C111, C142) * Spleen (C422) * Thymus (C379) **Note 3:** Spleen involvement only (C422) is a lymphatic site (structure); however, it is noted differently. * If only the spleen is involved, assign 2: S (Spleen, lymphomas, only) in the **Pathologic Stage (Prefix/Suffix) Descriptor** **Note 4:** Spleen involvement with a lymphatic or extralymphatic primary site is accepted if there is palpable enlargement of the spleen confirmed by imaging. (1) **Note 5:** Extralymphatic sites include all other sites (e.g., stomach, colon, breast, nasopharynx). * If an extralymphatic site is involved, assign 1: E (Extranodal, lymphomas, only) in the **Pathologic Stage (Prefix/Suffix) Descriptor** **Note 6:** If there is an extralymphatic site that also has Spleen involvement, assign 5: E (Extranodal and spleen, lymphomas, only) in the **Pathologic Stage (Prefix/Suffix) Descriptor**. **Note 7:** Lung involvement limited to one lobe, or perihilar extension associated with ipsilateral lymphadenopathy, or unilateral pleural effusion with or without lung involvement but with hilar lymphadenopathy is classified as localized extralymphatic disease. (1) **Note 8:** Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when assigning stage. **Note 9:** Clinical evidence of liver involvement must include either enlargement of the liver and at least an abnormal serum alkaline phosphatase level and two different liver function test abnormalities, or an abnormal liver demonstrated by imaging and one abnormal liver function test. (1) **Note 10:** Each stage should be divided into A and B according to the absence or presence of defined general symptoms. These are * Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to first attendance * Unexplained fever with temperature above 38 degree C * Night sweats **Note 11:** Pruritus alone does not qualify for B classification nor does a short, febrile illness associated with a known infection. **Note 12:** See **Site-Specific Factor #2, Systemic Symptoms at Diagnosis** to code the presence or absence of B symptoms.

Default

99

NAACCR Item

NAACCR #910

Metadata

None
Stage Stage Display Description Registrar Notes
1 Stage I Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I) OR

Localized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)
Presence of B symptoms unknown AND stated as Stage I, IE or IS
1A Stage IA Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I) OR

Localized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)

WITHOUT B symptoms
Stated as Stage IA, IEA or ISA
1B Stage IB Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I) OR

Localized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)

WITH B symptoms
Stated as Stage IB, IEB or ISB
2 Stage II Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR

Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement WITH or WITHOUT involvement of other lymph node regions on the same side of the diaphragm (IIE)
Note: The number of lymph node regions involvement may be indicated by a subscript. The number of involved regions is not coded by cancer registries

Presence of B symptoms unknown AND stated as Stage II, IIE, IIS, or IIES
2A Stage IIA Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR

Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement WITH or WITHOUT involvement of other lymph node regions on the same side of the diaphragm (IIE)

WITHOUT B symptoms
IIA, IIEA, IISA, or IIESA
2B Stage IIB Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR

Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement WITH or WITHOUT involvement of other lymph node regions on the same side of the diaphragm (IIE)

WITH B symptoms
IIB, IIEB, IISB, or IIESB
3 Stage III Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S Presence of B symptoms unknown AND stated as Stage III, IIIE, IIIS or IIIES
3A Stage IIIA Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S

WITHOUT B symptoms
Stated as Stage IIIA, IIIEA, IIISA or IIIESA
3B Stage IIIB Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S

WITH B Symptoms
Stated as Stage IIIB, IIIEB, IIISB or IIIESB
4 Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR

Stage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid
Presence of B symptoms unknown AND stated as Stage IV
4A Stage IVA Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR

Stage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid

WITHOUT B symptoms
Stated as Stage IVA
4B Stage IVB Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR

Stage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid

WITH B symptoms
Stated as Stage IVB
99 Stage Unknown Unknown, stage group not stated
Not documented in patient record
No staging laparotomy done
88 Not applicable Not applicable Death certificate only (DCO) case
(1) International Union Against Cancer (UICC) TNM Classification of Malignant Tumors, 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pgs., 184, 185