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What Are the Stages of Hodgkin Disease?

By using exams and tests, a doctor can tell the stage of a person's Hodgkin disease. The stage tells the doctor how much and how far the disease has spread. Staging is one of the most important factors in deciding what treatment to have for the disease.

The staging system used most often for Hodgkin is called the Cotswold's Modification of the Ann Arbor staging system. The stage of a person's lymphoma is indicated by Roman numerals I, II, III, and IV.

The letter B is added if the person has any B symptoms (fever, night sweats, weight loss). If a person does not have these B symptoms, the letter A is added after the Roman numeral. If the Hodgkin disease has spread from a lymph node to a nearby organ, the letter E is added. If it involves the spleen, the letter S may be added.

The letter X may be added if a person has bulky disease. This means a tumor in the chest is at least one-third as wide as the chest, or a tumor in another area is at least 10 centimeters (about 4 inches) across. This stage of the disease may need more intensive treatment: 

  • Stage I. Stage I means that the Hodgkin disease is only in one group of lymph nodes, or it has started in one organ and has not moved to another part of the body.

  • Stage II. Stage II means two or more groups of lymph nodes show cancer. The groups of lymph nodes must be on the same side of the diaphragm in the body; all disease is in either the upper or lower half of the body. This means that if the lymph nodes in the neck and underarms both show cancer, it is Stage II. However, if the lymph nodes in the groin and neck show cancer, it is not Stage II, because those two parts of the body are on different sides of the diaphragm. Cancer that is in one group of lymph nodes and extends directly into a nearby organ is also Stage II.

  • Stage III. Stage III means there are two or more groups of lymph nodes with Hodgkin disease on different sides of the diaphragm, such as the neck and groin. There might also be spread of the cancer from the lymph nodes to nearby organs.

  • Stage IV. Stage IV means the Hodgkin disease has spread widely through distant organ(s) outside of the lymphatic system. Other lymph nodes in the body may or may not show signs of the cancer. Typical Stage IV disease is when Hodgkin lymphoma is found in the bone marrow or in organs (lung, stomach, liver, bone) away from the involved lymph nodes.


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