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. Unlike advanced lymphomas (non-Hodgkin's lymphomas), Hodgkin’s disease does not tend to spread to the brain
The staging aims to look in all the places where Hodgkin's disease may spread for the possibility of involvement. Thus, these patients have a CT scan of the neck, chest, abdomen and pelvis as well as a whole body PET scan and a bone marrow examination. Blood tests are performed.
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.
Where there is disease outside the lymphoreticular system e.g. live or bone marrow, the patient is stage 4.
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 males do worse than females.