Stage III is disease on both sides of the diaphragm and Stage IV is diffuse extranodal involvement such as bone marrow, liver, central nervous system. The reason staging is important is because this influences prognosis and this influences treatment. The other reason staging is important is because if we know all the places patients have disease prior to treatment, then we go back and restage them after treatment to find out if we ve eradicated the disease. We also talked about symptom status. Symptom Status A is without symptoms.
B symptoms refer to fevers, weight loss and night sweats.
This is important because particularly in Hodgkin s disease, people who have these symptoms have a worse prognosis and may be treated differently than people without these symptoms and that s the reason we question people about this. Everyone gets a history and physical examination, lab, CT and bone marrow. Some patients may get additional studies such as a gallium scan which sometimes can help to distinguish between residual fibrosis in lymph nodes from active lymphoma. For limited stage Hodgkin s disease, which is generally Stage I and II, we have traditionally used radiation although there are now a lot of concerns about using a staging laparotomy before radiation and because of second malignancies from radiation. So some people are still recommending radiation.