Ann Arbor staging is the
staging
Staging may refer to:
Computing
* Staging (cloud computing), a process used to assemble, test, and review a new solution before it is moved into production and the existing solution is decommissioned
* Staging (data), intermediately storing data b ...
system for
lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enla ...
s, both in
Hodgkin's lymphoma
Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes. The condition w ...
(formerly designated Hodgkin's disease) and
non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tirednes ...
(abbreviated NHL). It was initially developed for Hodgkin's, but has some use in NHL. It has roughly the same function as
TNM staging in solid tumors.
The stage depends on both the place where the malignant tissue is located (as located with
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
,
CT scanning,
gallium scan
A gallium scan is a type of nuclear medicine test that uses either a gallium-67 (67Ga) or gallium-68 (68Ga) radiopharmaceutical to obtain images of a specific type of tissue, or disease state of tissue. Gallium salts like gallium citrate and gal ...
and increasingly
positron emission tomography) and on systemic symptoms due to the lymphoma ("
B symptoms
B symptoms are a set of symptoms, namely fever, night sweats, and unintentional weight loss, that can be associated with both Hodgkin lymphoma and non-Hodgkin lymphoma. These symptoms are not specific to lymphomas, especially each one considere ...
":
night sweats
Night sweats, also referred to as nocturnal hyperhidrosis (Hyperhidrosis - a medical term for excessive sweating + nocturnal - night), is the repeated occurrence of excessive sweating during sleep
Sleep is a sedentary state of mind and bo ...
,
weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat ( adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other co ...
of >10% or
fever
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
s).
Principal stages
The principal stage is determined by location of the tumor:
* ''Stage I'' indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
* ''Stage II'' indicates that the cancer is located in two separate regions, an affected lymph node or lymphatic organ and a second affected area, and that both affected areas are confined to one side of the diaphragm—that is, both are above the diaphragm, or both are below the diaphragm.
* ''Stage III'' indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
* ''Stage IV'' indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.
Modifiers
These letters can be appended to some stages:
* ''A'' or ''B:'' the absence of constitutional (
B-type) symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage.
* ''S:'' is used if the disease has spread to the
spleen
The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes . .
* ''E:'' is used if the disease is "extranodal" (not in the
lymph nodes) or has spread from lymph nodes to adjacent tissue.
* ''X:'' is used if the largest deposit is >10 cm large ("bulky disease"), or whether the
mediastinum is wider than ⅓ of the chest on a
chest X-ray.
Type of staging
The nature of the staging is (occasionally) expressed with:
* ''CS'': clinical stage as obtained by doctor's examinations and tests.
* ''PS'': pathological stage as obtained by exploratory laparotomy (surgery performed through an abdominal incision) with splenectomy (surgical removal of the spleen). Note: exploratory laparotomy has fallen out of favor for lymphoma staging.
Limitations
The staging does not take into account the ''grade'' (biological behavior) of the tumor tissue. The
prognostic significance of bulky disease, and some other modifiers, were introduced with the "Cotswolds modification".
History
The Ann Arbor classification is named after
Ann Arbor,
Michigan
Michigan () is a U.S. state, state in the Great Lakes region, Great Lakes region of the Upper Midwest, upper Midwestern United States. With a population of nearly 10.12 million and an area of nearly , Michigan is the List of U.S. states and ...
, where the Committee on Hodgkin's Disease Staging Classification met in 1971;
it consisted of experts from the United States,
UK, Germany and France, and replaced the older Rye classification from a 1965 meeting. The Cotswolds modification followed after a 1988 meeting in the UK
Cotswolds.
References
Further reading
*
{{Tumors
Anatomical pathology
Cancer staging
Lymphoma