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Staging Systems

Several staging systems have been developed and revised for HD. Currently, the procedure most often used is the Cotswold System, also known as the modified Ann Arbor Staging System, which is divided into four categories. These categories are further subdivided by the designations A, B, and E, which refer to the absence of symptoms, presence of symptoms, and extension of disease into a nearby organ, respectively.

The Cotswold System for HD Staging

Stage I:	HD involves one lymph node group or structure (spleen, thymus) or HD extends locally to involve a single adjacent site (Stage I E).
Stage II:	HD involves two or more lymph node groups on the same side of the diaphragm or HD involves one or more lymph node groups on the same side of the diaphragm and there is localized involvement of the node(s) to one organ or site on the same side of the diaphragm (Stage II E).
Stage III:	HD involves lymph node groups on both sides of the diaphragm, or HD may have extended to an organ or site next to the lymph node(s) and/or spleen (Stage III E)
	III 1 – with/without involved nodes of the spleen, hilum, abdomen, or liver III 2 – with involved nodes of the aorta (large artery arising from the left heart), iliac (pelvic) artery, or mesenteric (intestinal) artery
Stage IV:	HD has spread through the bloodstream to one or more organs or sites outside of the lymphatic system, with/ without associated lymph node involvement.

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