Ann Arbor staging is the staging system for lymphomas, 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 of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... This article is about lymphoma in humans. ... Hodgkins lymphoma, also known as Hodgkins disease, is a type of lymphoma first described by Thomas Hodgkin in 1832. ... Non-Hodgkin lymphoma is a cancer arising from lymphocytes, a type of white blood cells. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

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 fevers). Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... B symptoms are a feature of both Hodgkins lymphoma and non-Hodgkins lymphoma, and include: Fever Drenching sweats, especially at night Weight loss. ... Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle, bone mass, or fat. ... An analogue medical thermometer showing the temperature of 38. ...

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 within the lymphatic system 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 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 1/3 of the chest on a chest X-ray.

Lymph nodes are components of the lymphatic system. ... FIG. 967– Transverse section through the upper margin of the second thoracic vertebra The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. ... Frontal 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" (Lister et al 1989). Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ...

History

The Ann Arbor classification is named after Ann Arbor, 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 (Rosenberg 1966). The Cotswolds modification followed after a 1988 meeting in the UK Cotswolds. ^[1] For the railroad company, see Ann Arbor Railroad. ... Official language(s) None (English, de-facto) Capital Lansing Largest city Detroit Area  Ranked 11th  - Total 97,990 sq mi (253,793 km²)  - Width 239 miles (385 km)  - Length 491 miles (790 km)  - % water 41. ... The Cotswolds is the name given to a range of hills in central England, sometimes called the Heart of England, a hilly area reaching over 300 m or 1000 feet. ...

References

• Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the committee on Hodgkin’s disease staging classification. Cancer Res 1971;31:1860-1. PMID 5121694.
• Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, Rosenberg SA, Coltman CA, Tubiana M. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting. J Clin Oncol 1989 Nov;7(11):1630-6. PMID 2809679.
• Rosenberg SA. Report of the committee on the staging of Hodgkin’s disease. Cancer Res. 1966;26:1310.

1. ^ Mauch, Peter; James Armitage, Volker Diehl, Richard Hoppe, Laurence Weiss (1999). Hodgkin's Disease. Lippincott Williams & Wilkins, 223-228. ISBN 0-7817-1502-4. 

Year 1999 (MCMXCIX) was a common year starting on Friday (link will display full 1999 Gregorian calendar). ... Lippincott Williams & Wilkins is an academic & professional medical publisher, founded in 1792 and now part of the Wolters Kluwer group. ...

External link

• 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)