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{
  "id" : "stage_group_lymphoma_c_60180",
  "algorithm" : "tnm",
  "version" : "1.7",
  "name" : "Stage Group Lymphoma (c)",
  "title" : "Stage Group Lymphoma (c)",
  "notes" : "**Note 1:** Clinical stage describes the anatomic extent of Hodgkin and non-Hodgkin lymphoma and forms the basis for treatment decision. It is determined by history, clinical examination, imaging, and blood analysis. (1)\n* Bone marrow biopsy is indicated in selected cases and must be taken from a clinically or radiologically or non-involved area of bone\n\n**Note 2:** The lymphatic structures are as follows\n* Lymph nodes (C770-C779)\n* Waldeyer's ring (tonsils) (C024, C090-C099, C111, C142)\n* Spleen (C422)\n* Thymus (C379)\n    \n**Note 3:** Spleen involvement only (C422) is a lymphatic site (structure); however, it is noted differently. \n* If only the spleen is involved, assign 2: S (Spleen, lymphomas, only) in the **Clinical Stage (Prefix/Suffix) Descriptor**\n\n**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)\n\n**Note 5:** Extralymphatic sites include all other sites (e.g., stomach, colon, breast, nasopharynx). \n* If an extralymphatic site is involved, assign 1: E (Extranodal, lymphomas, only) in the **Clinical Stage (Prefix/Suffix) Descriptor**\n\n**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**.\n\n**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)\n\n**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.\n\n**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. (1)\n\n**Note 10:** Each stage should be divided into A and B according to the absence or presence of defined general symptoms. These are\n* Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to first attendance\n* Unexplained fever with temperature above 38 degree C\n * Night sweats\n\n**Note 11:**: Pruritus alone does not qualify for B classification nor does a short, febrile illness associated with a known infection.\n\n**Note 12:** See **Site-Specific Factor #2, Systemic Symptoms at Diagnosis** to code the presence or absence of B symptoms.",
  "last_modified" : "2018-04-11T19:53:02.741Z",
  "definition" : [ {
    "key" : "clin_stage_group_direct",
    "name" : "Stage",
    "type" : "INPUT"
  }, {
    "key" : "clin_stage_group_direct_display",
    "name" : "Stage Display",
    "type" : "DESCRIPTION"
  }, {
    "key" : "description",
    "name" : "Description",
    "type" : "DESCRIPTION"
  }, {
    "key" : "notes",
    "name" : "Registrar Notes",
    "type" : "DESCRIPTION"
  } ],
  "rows" : [ [ "1", "Stage I", "Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I)  OR\n\nLocalized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)", "Presence of B symptoms unknown AND stated as Stage I, IE or IS" ], [ "1A", "Stage IA", "Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I)  OR\n\nLocalized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)\n\nWITHOUT B symptoms", "Stated as Stage IA, IEA or ISA" ], [ "1B", "Stage IB", "Involvement of a single lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus or spleen) (I)  OR\n\nLocalized involvement of a single extralymphatic organ or site in the absence of any lymph node involvement (IE) (rare in Hodgkin lymphoma)\n\nWITH B symptoms", "Stated as Stage IB, IEB or ISB" ], [ "2", "Stage II", "Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR\n\nLocalized 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)", "Note: The number of lymph node regions involvement may be indicated by a subscript. The number of involved regions is not coded by cancer registries.\n\nPresence of B symptoms unknown AND stated as Stage II, IIE, IIS, or IIES" ], [ "2A", "Stage IIA", "Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR\n\nLocalized 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)\n\nWITHOUT B symptoms", "IIA, IIEA, IISA, or IIESA" ], [ "2B", "Stage IIB", "Involvement of two or more lymph node regions on the same side of the diaphragm (II) OR\n\nLocalized 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)\n\nWITH B symptoms", "IIB, IIEB, IISB, or IIESB" ], [ "3", "Stage III", "Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S", "Presence of B symptoms unknown AND stated as Stage III, IIIE, IIIS or IIIES" ], [ "3A", "Stage IIIA", "Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S\n\nWITHOUT B symptoms", "Stated as Stage IIIA, IIIEA, IIISA or IIIESA" ], [ "3B", "Stage IIIB", "Involvement of lymph node regions on both sides of the diaphragm (III), which also may be accompanied by extralymphatic extension in association with adjacent lymph node involvement (IIIE) or by involvement of the spleen (IIIS) or both (IIIE,S). Splenic involvement is designated by the letter S\n\nWITH B Symptoms", "Stated as Stage IIIB, IIIEB, IIISB or IIIESB" ], [ "4", "Stage IV", "Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR\n\nStage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid", "Presence of B symptoms unknown AND stated as Stage IV" ], [ "4A", "Stage IVA", "Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR\n\nStage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid\n\nWITHOUT B symptoms", "Stated as Stage IVA" ], [ "4B", "Stage IVB", "Diffuse or disseminated involvement of one or more extralymphatic organs, WITH or WITHOUT associated lymph node involvement OR\n\nStage IV includes any involvement of the liver or bone marrow, lungs (other than by direct extension from another site), or cerebrospinal fluid\n\nWITH B symptoms", "Stated as Stage IVB" ], [ "99", "Stage Unknown", "Unknown, stage group not stated\nNot documented in patient record", "No staging laparotomy done" ], [ "88", "Not applicable", "Not applicable", "Death certificate only (DCO) case" ] ]
}




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