Calculators & Tools

Hodgkin Lymphoma — Ann Arbor Stage

Ann Arbor staging (Toronto Tier 1) with Cotswolds modification.

1 What is the Hodgkin Lymphoma — Ann Arbor Stage?

The Hodgkin Lymphoma — Ann Arbor Stage is a oncology scoring tool used in paediatric practice. Ann Arbor staging (Toronto Tier 1) with Cotswolds modification. It scores 1 criteria and interprets the total across 4 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in oncology
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 1 criteria: Extent of disease. Totals are then banded: 1 stage or more - Stage I: stage I - limited disease. Usually low-risk therapy: short chemotherapy ± involved-site radiotherapy; 2 stage or more - Stage II: stage II - favourable or unfavourable depending on bulk and B symptoms; therapy is response-adapted; 3 stage or more - Stage III: stage III - advanced disease. Multi-agent chemotherapy with response-adapted radiotherapy; 4 stage or more - Stage IV: stage IV - disseminated. High-risk multi-agent chemotherapy; consider CHIPS for prognostication.
  • Suffix A = no systemic symptoms; B = fever >38 °C, drenching night sweats, or >10% weight loss in 6 months. Suffix E = limited contiguous extranodal extension; X = bulky disease.
  • Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

4 Frequently asked questions

How many criteria does the Hodgkin Lymphoma — Ann Arbor Stage use?

1. They are Extent of disease.

What do the bands of the Hodgkin Lymphoma — Ann Arbor Stage mean?

The total is interpreted as: 1 stage or more - Stage I: stage I - limited disease. Usually low-risk therapy: short chemotherapy ± involved-site radiotherapy; 2 stage or more - Stage II: stage II - favourable or unfavourable depending on bulk and B symptoms; therapy is response-adapted; 3 stage or more - Stage III: stage III - advanced disease. Multi-agent chemotherapy with response-adapted radiotherapy; 4 stage or more - Stage IV: stage IV - disseminated. High-risk multi-agent chemotherapy; consider CHIPS for prognostication.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Suffix A = no systemic symptoms; B = fever >38 °C, drenching night sweats, or >10% weight loss in 6 months. Suffix E = limited contiguous extranodal extension; X = bulky disease.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.