Ann Arbor staging

<h2 id="principal-stages">Principal stages</h2>
<p>The principal stage is determined by location of the tumor:
</p>
<ul><li><i>Stage I</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.</li>
<li><i>Stage II</i> indicates that the cancer is located in two separate regions, an affected lymph node or lymphatic 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.</li>
<li><i>Stage III</i> indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.</li>
<li><i>Stage IV</i> 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.</li></ul>
<h2 id="modifiers">Modifiers</h2>
<p>These letters can be appended to some stages:
</p>
<ul><li><i>A</i> or <i>B:</i> the absence of constitutional (<a href="/facts/B_symptoms/YAAr9kl5">B-type</a>) symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage.</li>
<li><i>S:</i> is used if the disease has spread to the <a href="/facts/Spleen/6NKn9d8s">spleen</a>.</li>
<li><i>E:</i> is used if the disease is "extranodal" (not in the <a href="/facts/Lymph_node/vkwfcQjH">lymph nodes</a>) or has spread from lymph nodes to adjacent tissue.</li>
<li><i>X:</i> is used if the largest deposit is >10 cm large ("bulky disease"), or whether the <a href="/facts/Mediastinum/mQUlFdhF">mediastinum</a> is wider than ⅓ of the chest on a <a href="/facts/Chest_X-ray/BUExu2WY">chest X-ray</a>.</li></ul>
<h2 id="type-of-staging">Type of staging</h2>
<p>The nature of the staging is (occasionally) expressed with:
</p>
<ul><li><i>CS</i>: clinical stage as obtained by doctor's examinations and tests.</li>
<li><i>PS</i>: 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.</li></ul>
<h2 id="limitations">Limitations</h2>
<p>The staging does not take into account the <i>grade</i> (biological behavior) of the tumor tissue. The <a href="/facts/Prognosis/3DEGwPag">prognostic significance</a> of bulky disease, and some other modifiers, were introduced with the "Cotswolds modification".<a class="footnote-ref" id="fnref:1" href="#fn:1"><sup>1</sup></a>
</p>
<h2 id="history">History</h2>
<p>The Ann Arbor classification is named after <a href="/facts/Ann_Arbor%2c_Michigan/hs3CBRJy">Ann Arbor, Michigan</a>, where the Committee on Hodgkin's Disease Staging Classification met in 1971;<a class="footnote-ref" id="fnref:2" href="#fn:2"><sup>2</sup></a> it consisted of experts from the United States, <a href="/facts/United_Kingdom/kuPAILt2">UK</a>, Germany and France, and replaced the older Rye classification from a 1965 meeting.<a class="footnote-ref" id="fnref:3" href="#fn:3"><sup>3</sup></a> The Cotswolds modification followed after a 1988 meeting in the UK <a href="/facts/Cotswolds/QjMzPUod">Cotswolds</a>.<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a>
</p>

<h2 id="further-reading">Further reading</h2>
<ul><li><a href="http://www.garfield.library.upenn.edu/classics1983/A1983RS45200001.pdf">"Current Contents/Clinical Practice 1983;50:22)—Prof. Paul P. Carbone commenting on the impact of the Ann Arbor classification"</a> (PDF). <i>Citation classics</i>. Institute for Scientific Information (ISI). December 1983.</li></ul>

<h2 id="references">References</h2>

<ol>
<li id="fn:1"><p>Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, et al. (November 1989). "Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting". Journal of Clinical Oncology. 7 (11): 1630–1636. doi:10.1200/JCO.1989.7.11.1630. PMID 2809679. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li>
<li id="fn:2"><p>Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (November 1971). "Report of the Committee on Hodgkin's Disease Staging Classification". Cancer Research. 31 (11): 1860–1861. PMID 5121694. <a href="http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=5121694" target="_blank">http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=5121694</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li>
<li id="fn:3"><p>Rosenberg SA (June 1966). "Report of the committee on the staging of Hodgkin's disease". Cancer Research. 26 (6 Part 1): 1310.
 <a href="https://aacrjournals.org/cancerres/article/26/6_Part_1/1310/476370/Report-of-the-Committee-on-the-Staging-of-Hodgkin" target="_blank">https://aacrjournals.org/cancerres/article/26/6_Part_1/1310/476370/Report-of-the-Committee-on-the-Staging-of-Hodgkin</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li>
<li id="fn:4"><p>Mauch P, Armitage J, Diehl V, Hoppe R, Weiss L (1999). Hodgkin's Disease. Lippincott Williams & Wilkins. pp. 223–228. ISBN 978-0-7817-1502-7. <a href="978-0-7817-1502-7" target="_blank">978-0-7817-1502-7</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li>
</ol>

Ann Arbor staging open-in-new

Ann Arbor staging