Staging is a critical element in treatment planning and should be clearly documented in the patient’s medical record.

Staging for aggressive Hodgkin lymphoma and DLBCL involves these tests:

• imaging with an FDG-PET/CT scan – where treatment may include radiation therapy, consultation with a radiation oncologist is required to determine any further imaging and evaluation needs before starting treatment (PET-CT scan should be performed as a radiation therapy planning scan in treatment position in selected patients)
• laboratory studies to evaluate LDH, calcium and urate (Armitage et al. 2017) – a full blood test should be performed and, if significantly abnormal, bone marrow biopsy should be considered
• determining a prognostic score using either the International Prognostic Score for Hodgkin lymphoma (Hasenclever & Diehl 1998) or the International Prognostic Index for DLBCL (Shipp 1993)
• central nervous system (CNS) evaluation including imaging and cerebrospinal fluid sampling in those subsets at high risk, or with clinical symptoms, as indicated by specific extra nodal sites of involvement, a high International Prognostic Index score and/or elevated serum LDH (note that Hodgkin lymphoma rarely involves the CNS and these evaluations are not routinely required in these patients; 5 per cent of cases of systemic DLBCL may involve the CNS).

Viral serology for HIV and hepatitis B/C can assist in refining the differential diagnosis and identifying risk factors for lymphoma as well as potential risks during treatment.

Visit the Cancer Institute New South Wales website for information about understanding the stages of cancer.