![]() Presence of B symptoms unknown AND stated as Stage II, IIE, IIS, or IIES The number of involved regions is not coded by cancer registries. Note: The number of lymph node regions involvement may be indicated by a subscript. Localized involvement of a single extralymphatic organ or site in association with regional lymph node involvement WITH or WITHOUT involvement of other lymph node regions on the same side of the diaphragm (IIE) Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR Presence of B symptoms unknown AND stated as Stage I, IE or IS Localized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma) Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I) OR **Note 12:** See **Site-Specific Factor #2, Systemic Symptoms at Diagnosis** to code the presence or absence of B symptoms. **Note 11:**: Pruritus alone does not qualify for B classification nor does a short, febrile illness associated with a known infection. * Unexplained fever with temperature above 38 degree C ![]() * Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to first attendance **Note 10:** Each stage should be divided into A and B according to the absence or presence of defined general symptoms. **Note 9:** Clinical evidence of liver involvement must include either enlargement of the liver and at least an abnormal serum alkaline phosphatase level and two different liver function test abnormalities, or an abnormal liver demonstrated by imaging and one abnormal liver function test. **Note 8:** Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when assigning stage. **Note 7:** Lung involvement limited to one lobe, or perihilar extension associated with ipsilateral lymphadenopathy, or unilateral pleural effusion with or without lung involvement but with hilar lymphadenopathy is classified as localized extralymphatic disease.(1) **Note 6:** If there is an extralymphatic site that also has Spleen involvement, assign 5: E (Extranodal and spleen, lymphomas, only) in the **Clinical Stage (Prefix/Suffix) Descriptor**. * If an extralymphatic site is involved, assign 1: E (Extranodal, lymphomas, only) in the **Clinical Stage (Prefix/Suffix) Descriptor** **Note 5:** Extralymphatic sites include all other sites (e.g., stomach, colon, breast, nasopharynx). **Note 4:** Spleen involvement with a lymphatic or extralymphatic primary site is accepted if there is palpable enlargement of the spleen confirmed by imaging.(1) * If only the spleen is involved, assign 2: S (Spleen, lymphomas, only) in the **Clinical Stage (Prefix/Suffix) Descriptor** **Note 3:** Spleen involvement only (C422) is a lymphatic site (structure) however, it is noted differently. **Note 2:** The lymphatic structures are as follows * Bone marrow biopsy is indicated in selected cases and must be taken from a clinically or radiologically or non-involved area of bone It is determined by history, clinical examination, imaging, and blood analysis. Notes **Note 1:** Clinical stage describes the anatomic extent of Hodgkin and non-Hodgkin lymphoma and forms the basis for treatment decision.
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