The staging of the tumour. One of the most interesting features of Hodgkin’s disease is that it tends to spread in a logical and orderly fashion. It tends to begin in one part of the lymphoreticular system and usually in a peripheral lymph node and then spreads to involve adjacent lymph nodal regions before going on again to the next and finally to disseminate to other organs, of which the liver and the bone marrow are the most important to detect and most prognostically serious.
The staging aims to look in all these places for the possibility of involvement. Thus, these patients have a CT scan of the chest, abdomen and pelvis as well as a bone marrow examination. Blood tests are performed and sometimes other scans e.g. PET scanning. From these staging tests are evolved the staging for each patient: one set of nodes involved only is stage 1. Where two sets of nodes are involved on one side of the diaphragm then the patient is stage 2. When there are lymph nodes groups (or spleen) involved on both sides of the diaphragm then the patient is stage 3 whereas the patient is stage 4 when there is disease outside the lymphoreticular system e.g. live or bone marrow. Additionally, it has been observed that patients with symptoms of heavy night sweats or significant weight loss of more than 10% of body weight or fever have a worse outlook stage for stage and therefore there has been devised an A versus B system where each patient is divided stage-wise into suffix A or B cases; thus a patient might ultimately be staged as stage 3B etc.
The staging system is important with regard to the therapy chosen and the eventual prognosis. However, some other factors contribute to the prognosis and it is noteworthy that older patients do less well than younger patients and that males do worse than females.
