Key Points
                    - After adult Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.     - There are three ways that cancer spreads in the body.    - Stages of adult Hodgkin lymphoma may include A, B, E, and S.    - The following stages are used for adult Hodgkin lymphoma:         - Stage I     - Stage II     - Stage III     - Stage IV        - Adult Hodgkin lymphoma may be grouped for treatment as follows:         - Early Favorable     - Early Unfavorable     - Advanced
                
                
                    After adult Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
                    The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:          -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For adult Hodgkin lymphoma, CT scans of the neck, chest, abdomen, and pelvis are taken.    -   PET-CT scan : A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.    -   Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.         For pregnant women with Hodgkin lymphoma, staging tests that protect the fetus from the harms of radiation are used. These include:         -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).     -   Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
                
                
                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
                
                
                    Stages of adult Hodgkin lymphoma may include A, B, E, and S.
                    Adult Hodgkin lymphoma may be described as follows:         - A: The patient does not have B symptoms (fever, weight loss, or night sweats).    - B: The patient has B symptoms.    - E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.    - S: Cancer is found in the spleen.
                
                
                    The following stages are used for adult Hodgkin lymphoma:
                    Stage I      Stage I is divided into stage I and stage IE.            - Stage I: Cancer is found in one of the following places in the lymph system:                  - One or more lymph nodes in one lymph node group.       - Waldeyer's ring.       -  Thymus.       -  Spleen.                - Stage IE: Cancer is found outside the lymph system in one organ or area.              Stage II      Stage II is divided into stage II and stage IIE.            - Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).     - Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.              Stage III      Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIE,S.            - Stage III: Cancer is found in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).     - Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.      - Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.     - Stage IIIE,S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.               Stage IV     In stage IV, the cancer:            - is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or     - is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or     - is found in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.
                
                
                    Adult Hodgkin lymphoma may be grouped for treatment as follows:
                    Early Favorable    Early favorable adult Hodgkin lymphoma is stage I or stage II, without risk factors.        Early Unfavorable    Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one or more of the following risk factors:            - A tumor in the chest that is larger than 1/3 of the width of the chest or at least 10 centimeters.     -  Cancer in an organ other than the lymph nodes.     - A high sedimentation rate (in a sample of blood, the red blood cells settle to the bottom of the test tube more quickly than normal).     - Three or more lymph nodes with cancer.     - Symptoms such as fever, weight loss, or night sweats.              Advanced    Advanced Hodgkin lymphoma includes some or all of the following risk factors:            - Being male.      - Being aged 45 years or older.      - Having stage IV disease.      - Having a low blood albumin (protein) level (below 4).      - Having a low hemoglobin level (below 10.5).      - Having a high white blood cell count (15,000 or higher).      - Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).