Anaplastic large cell lymphoma

If you're diagnosed with anaplastic large cell lymphoma (ALCL), the next step is to determine the cancer's extent, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of your ALCL. Your healthcare team uses the cancer stage to help create your treatment plan.

ALK-positive ALCL and ALK-negative ALCL staging

The stages of ALK-positive and ALK-negative ALCL range from 1 to 4:

• Stage 1 lymphoma. At stage 1, anaplastic large cell lymphoma affects only one lymph node region or one site outside of the lymph nodes.
• Stage 2 lymphoma. A stage 2 anaplastic large cell lymphoma involves two or more lymph node regions on the same side of the diaphragm.
• Stage 3 lymphoma. At stage 3, anaplastic large cell lymphoma involves lymph node regions on both sides of the diaphragm or lymph nodes above the diaphragm and the spleen.
• Stage 4 lymphoma. At stage 4, anaplastic large cell lymphoma involves regions outside of the lymph nodes.

Primary cutaneous ALCL staging

Primary cutaneous ALCL is staged using the TNM staging system. TNM stands for tumor, node and metastases.

For primary cutaneous ALCL, tumor refers to the number of lesions present on the skin, where they are located and how big they are:

• T0. No lesions are present.
• T1. Only one patch, lesion or nodule is present in one area of the skin.
• T2. Multiple lesions are present. The lesions may be close together in one area of the skin or located in two areas of the skin that are near each other.
• T3. Multiple lesions are present in multiple areas of the skin not near each other.

Node refers to whether the lymph nodes are affected:

• N0. No lymph nodes are affected.
• N1. One lymph node region is affected.
• N2. More than two lymph node regions are affected.
• N3. The cancer has spread to the central lymph nodes.

Metastases refers to whether the cancer has spread to other parts of the body:

• M0. The cancer has not spread beyond the skin.
• M1. The cancer has spread to other organs, such as the liver, lungs, bone marrow or spleen.

For example, an early-stage primary cutaneous ALCL may be labeled T1N0M0. A late-stage primary cutaneous ALCL that is more aggressive and has spread beyond the skin may be labeled T3N3M1.

Breast implant-associated ALCL staging

Breast implant-associated (BIA) ALCL is staged using the TNM staging system. TNM stands for tumor, node and metastases.

For BIA ALCL, tumor refers to whether the cancer is confined to the breast:

• T1. The cancer is confined to the fluid around the implant or the surface of the scar tissue surrounding the breast implant, called the capsule.
• T2. The cancer starts to grow into the capsule.
• T3. The cancer is growing deeper into the capsule in noticeable clusters or sheets of cells.
• T4. The cancer has spread beyond the capsule and into nearby tissue.

Node refers to whether the lymph nodes are affected:

• N0. No lymph nodes are affected.
• N1. One lymph node region is affected.
• N2. More than two lymph node regions are affected.

Metastases refers to whether the cancer has spread to other parts of the body:

• M0. The cancer has not spread beyond the breast.
• M1. The cancer has spread to other organs or distant parts of the body.

For example, an early-stage BIA ALCL may be labeled T1N0M0. A late-stage BIA ALCL that is more aggressive and has spread beyond the breast may be labeled T4N2M1.