Staging of lymphoma: prognostic and therapeutic significance

Staging of lymphoma currently has greatest impact on the management of Hodgkin's disease, but it is also applicable to some forms of non Hodgkin's lymphoma. There are a number of important exceptions to the staging criteria as presently conceived, however. For example, lymphoma involving extranodal structures is usually a diffuse form of disease, for which the prognosis is poor. But the nodular sclerosis form of Hodgkin's disease, which generally involves mediastinal lymph nodes, may extend directly into adjacent lung tissue and still respond to radiotherapy alone. Another exception is nodular non Hodgkin's lymphoma, which may be more extensive at initial presentation than diffuse non Hodgkin's lymphoma but generally has a much better prognosis. Finally, Burkitt's lymphoma, a tumor characteristically involving extranodal structures, may in many instances respond dramatically to chemotherapy. Notwithstanding the exceptions, it is only since the advent of staging that clinicians have been able to speak of a 'cure' in relation to Hodgkin's disease.