Stages of Mesothelioma
Staging is a prognosis tool used to determine how far a case of cancer has spread. It may affect what treatment options are available and/or most likely to be effective for the patient. Pleural mesothelioma, the most common form, may be staged using a few systems. There are currently no formal staging systems for the other forms of mesothelioma.
Pleural Mesothelioma Staging Systems
There are currently three main staging systems used by doctors to determine how far a patient’s mesothelioma has progressed. Each system uses 4 stages to describe the progression of a particular case, but the definitions of each stage vary slightly according to the method used.
Butchart Staging System
The Butchart System is the most widely recognized and most commonly used staging system for pleural mesothelioma. This system looks at tumor size and spread to determine stage:
- Stage 1: The mesothelioma has affected the right or left side of the pleural lining and may be seen in the diaphragm.
- Stage 2: Both sides of the lungs show the presence of malignant mesothelioma, as do the lymph nodes. In Stage 2, the disease may also have spread to the heart, stomach, or esophagus.
- Stage 3: In Stage 3, the mesothelioma has reached the peritoneum (lining of the abdominal cavity) as well as lymph nodes past the chest.
- Stage 4: The cancer has entered the bloodstream and spread to additional organs that are not contiguous to the pleura.
TNM Staging System
The TNM System was developed by the American Joint Committee on Cancer. It is similar to the Butchart system and takes cues from staging systems created for other types of cancer. This system weighs not only the condition of tumors but also the effect of mesothelioma on the lymph nodes and whether the cancer has spread (metastasized) to other parts of the body.
TNM stands for tumor (T), node (N), and metastasis (M)—the three factors a doctor must consider when using this staging system. When using the TNM staging system, your doctor will ask:
- (Tumor) How large is the primary tumor and what is its location?
- (Node) Has the tumor metastasized to the lymph nodes?
- (Metastasis) Has the tumor metastasized to other organs?
Substages Within the TNM System
The TNM staging system allows doctors to denote a patient’s disease with a high level of specificity. Here are the values doctors use to describe a patient’s diseases by category.
Tumor size and location:
- T0 – No tumor exists
- T1 – The tumor has penetrated the ipsilateral (one side of the) pleura.
- T2 – Either of the ipsilateral pleural membranes is involved and the tumor has also penetrated either the diaphragm or the lung.
- T3 – In addition to pleural membrane involvement, one of the following conditions also exists: Invasion of the membrane that surrounds the thorax; invasion into the area of the chest between the lungs; one area of invasion into the chest wall muscles; or slight invasion into the lining around the heart.
- T4 – The tumor has invaded more than one area of the chest wall; the abdominal cavity; other organs in the chest; the spine; and/or the pericardium (the membrane surrounding the heart) OR the mesothelioma is affecting both pleura.
- TX – This designation means that the doctor was unable to evaluate the tumor.
Lymph node metastasis:
- N0 – The cancer has not spread to the lymph nodes in the area around the tumor.
- N1 – The cancer has spread to the lymph nodes either inside or outside of the pleura.
- N2 - It has spread to the lymph nodes in the area between the lungs on both sides of the body, the lymph nodes near the breast bone, and/or the lymph nodes above the collar bone on one or both sides of the body
- NX – this designation means the doctor was unable to evaluate the lymph nodes around the tumor.
Spread to other organs:
- M0 – The cancer has not metastasized to other organs.
- M1 – The cancer has spread to other organs.
Determining the Cancer Stage in the TNM System
Once the doctor has finished the TNM assessment, the information from the various subgroups is then combined to assign the stage of the cancer. Your doctor may choose to use letters to further differentiate (stages 1A/1B, for example).
- Stage 1: The malignant mesothelioma is in either the right or the left pleura. It may have also spread to one lung, the heart, or the diaphragm on the same side.
- Stage 2: The cancer has reached a lymph node on the same side of the body as the affected lung. It has also spread to the lung on the same side as the tumor, or to the heart or diaphragm.
- Stage 3: The mesothelioma has entered the abdominal cavity and lymph nodes beyond the chest.
- Stage 4: The mesothelioma has spread throughout the pleural area as well as to the lymph nodes on both sides of the body. The cancer may also have reached additional organs or the abdomen at this stage.
Brigham Staging System
The Brigham System is the most modern mesothelioma staging system. Unlike the Butchart and the TNM Systems, the Brigham system also assesses the anticipated effectiveness of surgical intervention at each stage.
- Stage 1: The mesothelioma tumor is still removable and lymph nodes are unaffected by the cancer.
- Stage 2: Lymph nodes are affected but the cancer can still be removed surgically.
- Stage 3: When the mesothelioma has reached the heart, chest cavity, abdominal cavity, or the diaphragm, surgical intervention is no longer a viable treatment option.
- Stage 4: The mesothelioma has metastasized throughout the body and could not be removed by surgery.
Treatment of Mesothelioma by Stage
Unfortunately, mesothelioma is rare enough and its symptoms so nonspecific it is not usually diagnosed until a patient has already reached the later stages of the cancer. Anyone who is aware of asbestos exposure in their past should let their doctor know for this reason. By closely monitoring lung health, they may be able to catch tumor growth before it spreads throughout the body.
The earlier a case of mesothelioma can be detected, the much better a patient’s prognosis.
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