Non-Hodgkin lymphoma staging allows doctors and cancer researchers to approximate the extent of dispersal of the disease. The contemporary staging system for Non-Hodgkin Lymphoma (NHL) is identified using the Lugano classification in adults. It is based on the older Ann Arbor system. Various stages of the incurable disease are defined by means of Roman numerals from I to IV.

While the lymph system is denoted by an extra (E), lymphomas belonging to stage I or stage II (collectively known as the limited stage) affect an organ outside, known as the Extranodal organ.

Stage I

• Lymphoma is a single lymph node area or a lymphoid organ, such as the tonsils (I).
• Lymphoma is spotted only in one area of a single organ, outside the lymph system (IE).

Stage II

• Lymphoma is in 2 or more lymph node groups on the same side, either above or below, of the think band of muscle that separates abdomen or chest, known as the diaphragm.
• Lymphoma is in a specific group of lymph node(s) in addition to being in one area of a nearby organ (IIE). It can affect other lymph node groups on the same side of the diaphragm.

Stage III
The stage III of non-Hodgkin lymphoma is identified by means of one of the two conditions.

• Lymphoma is in the lymph node areas on either side of the diaphragm.
• Lymphoma is in the lymph nodes above the diaphragm and also in the spleen.

Stage IV
In stage IV of non-Hodgkin lymphoma, the lymphoma spreads greatly into at least one organ outside, such as the bone marrow, liver, and lung.

Non-Hodgkin lymphoma – Treatment
The dosage and frequency of the Non-Hodgkin lymphoma treatment varies from stage to stage and on the extent of the disease. Primarily, four techniques are used in Non-Hodgkin lymphoma treatment. These four treatments are chemotherapy, medication, radiation therapy, and stem-cell transplant. Each one of them is briefed up as follows:

Chemotherapy
Chemotherapy is a very wide category of cancer treatment, which makes use of one or more anti-cancer drugs, known as chemotherapeutic agents. As such, it is also used in various cases of non-Hodgkin lymphoma. It is also known as chemo, CTx, and CTX. There are several uses of chemotherapy for treating cancer, ranging from prolonging life and reducing symptoms to using for a curative intent.

Radiation therapy
Also known as RT, XRT, and RTx, radiation therapy makes use of ionizing radiation and is used as part of Non-Hodgkin lymphoma treatment. It assists in killing and controlling malignant cells (cancer cells). It is also used as part of adjuvant therapy and for preventing tumor recurrence after a tumor removal surgery. It is synergistic to chemotherapy, i.e. it can be used before, after, or even during chemotherapy in different types of cancers, such as the non-Hodgkin lymphoma.

Stem-cell transplant
Used in leukemia, multiple myeloma, and other forms of cancer, in addition to treating some types of lymphoma, stem cell transplant treats non-cancer related blood diseases. Stem cells are actually undifferentiated cells of a multicellular organism, like humans, capable of producing desired cells required by the body. Previously, stem cells for treating cancer and other medical conditions were collected from the bone marrow. In the present day, stem cells used for treatment and research are collected from the blood.

There are several types of stem cell transplants used in Non-Hodgkin lymphoma treatment. Many of them are under research, such as the umbilical cord blood transplant, parent-child transplant and haplotype mismatched transplant. Two primary types used in lymphoma are:

• AUTO (Autologous) transplant – This type of stem cell transplant is also known as the high-dose chemotherapy with autologous stem cell rescue. In this transplant, a patient is injected with one’s own stem cells. Stem cells are collected from the blood and frozen for later use.
• ALLO (Allogenic) transplant – Unlike AUTO transplant, stem cells from another person are taken in ALLO Transplant. For this, the bone marrow of the donor and receiver must be similar. The most important factor is the levels of HLA (Human Leukocyte Antigens). The best donor is whose HLA levels are the most similar to that of the receiver. There are 2 main types of ALLO transplants, Ablative, which makes use of a high dosage of chemotherapy and reduced intensity, which makes milder doses of chemotherapy.

Medication
Primary Non-Hodgkin lymphoma treatment methods through medication are:

• Chemotherapy – It is one of the most effective Non-Hodgkin lymphoma treatments. It helps in killing cells growing or multiplying at a very rapid rate
• Bone marrow stimulant – Used only in some forms of cancer, bone marrow stimulant helps in producing new blood cells in the patient.
• Steroid – Often used for reducing inflammation, boosting tissue growth, and repair, steroid modifies or simulates hormonal effects.