How is follicular lymphoma staged?

How do I know the stage of my follicular lymphoma?

So the staging of follicular lymphoma is typically done by imaging. So we will use something called a CT or a PET scan. And the staging has to do with how far advanced the disease is throughout the body. For example, if you just have one group of lymph nodes, for example, under the arm, if you only have lymph nodes there and nowhere else, that would be an early stage such as a stage one or stage two. If you have lymph nodes above and below the diaphragm, for example, lymph nodes in the chest and lymph nodes in the abdomen, we would call that a stage three. And then if you had disease that was in the lymph nodes and in solid organs such as the lung, the liver, the gastrointestinal tract, that would be a stage four. But the staging is based typically on imaging or biopsies. Yeah so staging in follicular lymphoma and lymphomas in general is is I think different than other cancers and many people have some sort of personal experience with a family member or a friend that has a, you know, a cancer diagnosis. And then they get told a stage in lymphomas, most most lymphomas we see, including follicular lymphoma, we're going to be what we call extensive stage. So the staging is a little bit different than other cancers. Also, we tend to use what's called a Ann Arbor stage or a modified Ann Arbor stage. And it really looks at where in the body and lymph nodes are basically a, you know, diagnosis. So that can range from just a single group or one lymph node. So more I'm pointing to the neck because there's a lot of nodes in the neck or multiple lymph nodes kind of on the same side of the body. And we usually use the diaphragm muscle. The breathing muscle is kind of the cut for that. And that would, you know, if it's a single area that would be stage one. If it's multiple areas on the same side of the diaphragm, that would be what we call stage two. If it's beyond that in multiple enough node areas, that would be stage three. And then if it's in the organs that are not sort of lymph nodes or the spleen, things like the bone marrow or liver or lungs will generally stay that stage four, which is kind of the maximal extent for that staging classification. There are things sometimes we'll ask patients and discuss and incorporate to the staging schemes or whether they have what's called B symptoms. B symptoms are things that come up as part of the body's reaction to lymphoma being in the body. Most often those are things like night sweats, like really drinking night sweats where patients have to change their clothes or bed sheeting, those sorts of things. Sometimes with that can be elevated temperatures or fevers. Sometimes those things will cause patients to lose weight. Sometimes those things will cause patients to lose weight. And so we have criteria around that. And so often you might see, you know, in clinic notation or or in a consultation, you know, a stage which, you know, so could be Ann Arbor Stage two, but also a B sometimes, you know, it could be stage two or three. B, it's these combinations of different staging schemes. The other thing that we look at that's beyond stage, again, because most patients are, you know, advanced stage, that's actually less important for prognosis. It doesn't necessarily change how treatable or how long, you know, how long a patient's going to live or how they're going to do with the lymphoma. We can turn to other kind of prognostic schemes. And usually those use some combination of the stage and then things like laboratory values, like whether the patient has anemia or an elevated lactate dehydrogenase level. And so we get into these other kind of prognostic schemes. There are some later as you can use for things like the floppy score, which is follicular Lymphoma International Prognostic index. Many of these things are very specific, sophisticated and actually evolving even as we speak. But those are things patients may also additionally encounter in terms of their journey with follicular lymphoma. that's a really important question. There are two things that I would like to emphasize. So first of all, the way we stage follicular lymphoma is to a specific stage in system called Ann Arbor Stage. And so if patients have lymph nodes only on one side of the diaphragm in the diaphragm is the big muscle that divides the chest from the abdomen. If they're only from on one side, we call those one stage one or two. You want to use that. If it's only one lymph node, two if is more than one, and that's early stage, if it's on both sides of the diaphragm or if the lymphoma goes outside of the lymph nodes, typically in the bone marrow, then we call that stage three or four somewhat up as stage. However, one thing that is really important to know is that differently from solid tumors where stage can meaningfully affect life expectancy, the same doesn't hold true for lymphoma in general. So in B-cell lymphoma, definitely those who have early stage may have overall better outcome, but life expectancy doesn't change meaningfully and usually staging is more a piece of information for us to know whether radiation would be part of treatment. I'm saying this because understandably in many patients with B-cell lymphoma and particularly follicular lymphoma will get then knows the first time. And the reason their charts that the lymphoma is a stage four, they immediately think of stage four lung cancer or stage four colon cancer. But that has a completely different meaning. That's something that we always emphasize to our patients when we meet them for the first time.