Ann Arbor staging
Encyclopedia
Ann Arbor staging is the staging
system for lymphoma
s, both in Hodgkin's lymphoma
(previously called Hodgkin's disease) and Non-Hodgkin lymphoma
(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
, CT scanning and increasingly positron emission tomography
) and on systemic symptoms due to the lymphoma ("B symptoms
": night sweats
, weight loss
of >10% or fever
s).
of bulky disease, and some other modifiers, were introduced with the "Cotswolds modification".
, Michigan
, where the Committee on Hodgkin's Disease Staging Classification met in 1971; it consisted of experts from the USA, 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
.
Cancer staging
The stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
system for lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
s, both in Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a cancer originating from white blood cells called lymphocytes...
(previously called Hodgkin's disease) and Non-Hodgkin lymphoma
Non-Hodgkin lymphoma
The non-Hodgkin lymphomas are a diverse group of blood cancers that include any kind of lymphoma except Hodgkin's lymphomas. Types of NHL vary significantly in their severity, from indolent to very aggressive....
(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
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
, CT scanning and increasingly positron emission tomography
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
) and on systemic symptoms due to the lymphoma ("B symptoms
B symptoms
B symptoms refer to systemic symptoms of fever, night sweats, and weight loss which can be associated with both Hodgkin's lymphoma and non-Hodgkin's lymphoma...
": night sweats
Sleep hyperhidrosis
Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating during sleep. The sufferer may or may not also suffer from excessive perspiration while awake....
, weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
of >10% or fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
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 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.
- E: is used if the disease is "extranodal" (not in the lymph nodeLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s) 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 mediastinumMediastinumThe mediastinum is a non-delineated group of structures in the thorax, surrounded by loose connective tissue. It is the central compartment of the thoracic cavity...
is wider than 1/3 of the chest on a chest X-rayChest X-rayIn medicine, a chest radiograph, commonly called a chest X-ray , is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures...
. - S: is used if the disease has spread to the spleenSpleenThe spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
.
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 significancePrognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
of bulky disease, and some other modifiers, were introduced with the "Cotswolds modification".
History
The Ann Arbor classification is named after Ann ArborAnn Arbor, Michigan
Ann Arbor is a city in the U.S. state of Michigan and the county seat of Washtenaw County. The 2010 census places the population at 113,934, making it the sixth largest city in Michigan. The Ann Arbor Metropolitan Statistical Area had a population of 344,791 as of 2010...
, Michigan
Michigan
Michigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake"....
, where the Committee on Hodgkin's Disease Staging Classification met in 1971; it consisted of experts from the USA, UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
and France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, and replaced the older Rye classification from a 1965 meeting. The Cotswolds modification followed after a 1988 meeting in the UK Cotswolds
Cotswolds
The Cotswolds are a range of hills in west-central England, sometimes called the Heart of England, an area across and long. The area has been designated as the Cotswold Area of Outstanding Natural Beauty...
.
External links
- Citation classics (PDF, Current Contents/Clinical Practice 1983;50:22) - Prof Paul P. Carbone commenting on the impact of the Ann Arbor classification (from the Citation Classics library)