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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Oncology

Pathology, Staging, and Your Risk Score

At a Glance

Classic Hodgkin lymphoma (cHL) is confirmed using pathology markers like CD30 and CD15. Doctors use Lugano staging, B symptom evaluation, and the IPS risk score to determine your prognosis, and rely on an interim PET (iPET) scan to personalize and adjust your ongoing treatment.

Understanding your pathology and staging is like learning the “language” of your cancer. This information allows your medical team to move beyond a general diagnosis and create a treatment plan tailored specifically to you.

Decoding the Pathology: Biomarkers

When a pathologist looks at your biopsy, they use a process called immunohistochemistry (IHC) to identify specific proteins, or biomarkers, on the surface of the cancer cells [1].

In classic Hodgkin Lymphoma (cHL), the Hodgkin and Reed-Sternberg (HRS) cells have a very specific “fingerprint”:

  • CD30+ and CD15+: These markers are almost always present on the cancer cells [1][2].
  • CD45- and CD20-: Unlike most other lymphomas, the cancer cells in cHL typically lack these common B-cell markers [3][4].

If your report shows these specific markers, it confirms you have the “classic” form of the disease rather than a different type, like Non-Hodgkin Lymphoma or Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) [3][5].

Determining the Stage: Lugano Classification

The Lugano classification is the modern standard for staging Hodgkin Lymphoma, primarily using PET-CT scans to see where the cancer is located [6][7].

Stage Description
Stage I Cancer is in one lymph node region.
Stage II Cancer is in two or more lymph node regions on the same side of the diaphragm (the muscle below your lungs) [7].
Stage III Cancer is in lymph node regions on both sides of the diaphragm [6].
Stage IV Cancer has spread widely into organs like the liver, bone marrow, or lungs [7].

Your stage may also include additional letters that provide crucial details:

  • “B”: If you have “B symptoms”—unexplained fevers, drenching night sweats, or losing more than 10% of your body weight in six months [8][7]. If you don’t have these, you are Stage “A”.
  • “E”: Indicates Extranodal involvement, meaning the cancer has spread from a lymph node into a nearby organ outside the lymphatic system [6].
  • “X” or “Bulky”: Indicates a very large tumor mass, often found in the chest (mediastinum). This is common in young adults and may influence whether radiation is used in your treatment plan [7].

Assessing Risk: The IPS Score

For patients with advanced-stage disease, doctors use the International Prognostic Score (IPS), also known as the Hasenclever Index [9]. One point is assigned for each of these 7 factors present at diagnosis:

  1. Age: 45 years or older.
  2. Sex: Male.
  3. Stage: Stage IV disease.
  4. Albumin (protein): Level less than 4 g/dL.
  5. Hemoglobin (red blood cells): Level less than 10.5 g/dL.
  6. White Blood Cell Count: 15,000/μL or higher.
  7. Lymphocyte Count: Less than 600/μL (or less than 8% of total white cells) [9].

A higher score suggests the disease may be more challenging to treat, though modern therapies have made this score less predictive of success than it used to be [10][9].

The Critical Role of Interim PET (iPET)

The most important tool in modern Hodgkin treatment is the interim PET (iPET) scan, usually performed after two cycles of chemotherapy [11][12].

This scan tells the doctor exactly how “sensitive” your cancer is to the treatment. If the scan is clear (iPET-negative), your doctor may de-escalate your treatment—removing certain drugs (like bleomycin) to reduce toxic side effects while maintaining the cure rate [13][14]. If the scan shows the cancer is still active, they may intensify the treatment to ensure the best possible outcome [15]. This “response-adapted” approach is one of the main reasons survival rates for cHL are so high today [12].

Common questions in this guide

What does CD30 positive mean on my classic Hodgkin lymphoma pathology report?
Being CD30 positive means this specific protein was found on the surface of your cancer cells. Along with CD15, this is a classic fingerprint for Hodgkin and Reed-Sternberg cells, confirming your diagnosis of classic Hodgkin lymphoma.
What are 'B symptoms' in Hodgkin lymphoma staging?
B symptoms include unexplained fevers, drenching night sweats, and losing more than 10 percent of your body weight over six months without trying. Having these symptoms adds a 'B' to your stage and helps your doctor determine the best treatment approach.
How is the IPS risk score used for advanced Hodgkin lymphoma?
The International Prognostic Score (IPS) uses seven factors, including your age, stage, and specific blood counts, to assess how challenging your cancer might be to treat. While it helps doctors evaluate risk initially, modern therapies have made this score less predictive than it used to be.
Why is the interim PET (iPET) scan so important during treatment?
An interim PET scan is usually done after two cycles of chemotherapy to see how well the cancer is responding to treatment. If the scan is clear, your doctor may reduce your medication to minimize long-term side effects. If the cancer is still active, they may intensify your treatment to ensure the best outcome.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What was my total International Prognostic Score (IPS), and which of the 7 factors did I meet?
  2. 2.On my pathology report, were the Reed-Sternberg cells positive for CD30 and CD15?
  3. 3.Am I classified with 'A' or 'B' symptoms, and are there 'E' or 'Bulky' designations on my staging?
  4. 4.If my interim PET (iPET) scan after two cycles is clear, will we consider reducing the intensity of my treatment to avoid long-term side effects?
  5. 5.How does the size or location of my tumor influence the decision to use radiation therapy in my case?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (15)
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    American Registry of Pathology Expert Opinions: Immunohistochemical evaluation of classic Hodgkin lymphoma.

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    Annals of diagnostic pathology 2019; (39()):105-110 doi:10.1016/j.anndiagpath.2019.02.001.

    PMID: 30802809
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    Classic Hodgkin lymphoma: An illustrative review of select diagnostic limitations and immunomorphological challenges.

    El Hussein S, O'Malley DP

    Human pathology 2025; (156()):105678 doi:10.1016/j.humpath.2024.105678.

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    Patients with Classical Hodgkin Lymphoma with Less Than 10.5 CD20-Positive Reed-Sternberg Cells in 10 High-Power Fields Have Better Prognosis.

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    Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion 2022; (38(3)):596-600 doi:10.1007/s12288-021-01517-7.

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    Histopathologic Features and Differential Diagnosis in Challenging Cases of Nodular Lymphocyte Predominant B-cell Lymphoma/Nodular Lymphocyte Predominant Hodgkin Lymphoma.

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    Journal of clinical and translational pathology 2024; (4(2)):61-69 doi:10.14218/jctp.2024.00015.

    PMID: 39070246
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    A comparison of clinical staging using the Lugano versus Ann Arbor classifications in Japanese patients with Hodgkin lymphoma.

    Makita S, Maruyama D, Maeshima AM, et al.

    Asia-Pacific journal of clinical oncology 2020; (16(3)):108-114 doi:10.1111/ajco.13248.

    PMID: 31802636
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    The classic prognostic factors in advanced Hodgkin's lymphoma patients are losing their meaning at the time of Pet-guided treatments.

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    Investigating early progression of Hodgkin lymphoma in a two-center analysis.

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    The clinical value of interim PET/computed tomography scanning in patients with classical Hodgkin's lymphoma and its influence on prognosis in Duhok Province, Kurdistan Region - Northern Iraq.

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    Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients.

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This page explains classic Hodgkin lymphoma pathology, staging, and risk scores for educational purposes only. Always consult your oncologist to interpret your specific scan results and staging details.

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