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MESOTHELIOMA STAGING
Staging is a method of evaluating the progress of
cancer in a patient. It looks at the mesothelioma and the extent to which it has
developed and its possible spread to other parts of the body. Since
pleural mesothelioma occurs
most frequently and has been studied the most, it is the only mesothelioma for
which a staging classification exists.
Several medical approaches are utilized to determine the staging of mesothelioma,
including x-rays, CT scans, and MRI scans. The advancement, extent, and spread
of the cancer determines the stage of the mesothelioma, and determines the
treatment and outlook for the patient.
There are three recognized clinical staging systems for evaluating the spread
and extent of pleural mesothelioma: The Butchart System, TNM Staging, and the
Brigham System. The Butchart System has been the standard staging method for
most cancers, including mesothelioma. The TNM Staging system is beginning to be
used by major cancer centers as a more accurate method for specifically
evaluating mesothelioma. The Brigham System is one of the latest methods for the
staging of mesothelioma.
Butchart Staging System
The staging system used in the past for mesothelioma is the Butchart system.
This system is based mainly on the extent of the primary tumor mass, and divides
mesotheliomas into stages I through IV. Many doctors will still use this system.
- Stage I: Mesothelioma is present within
the right or left pleura, and may also involve the lung, pericardium, or
diaphragm (the muscle separating the chest from the abdomen) on the same side.
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Stage II: Mesothelioma invades
the chest wall or involves the esophagus (food passage connecting the throat
to the stomach), heart, or pleura on both sides. The lymph nodes in the chest
may also be involved.
-
Stage III: Mesothelioma has
penetrated through the diaphragm into the peritoneum (lining of the abdominal
cavity). Lymph nodes beyond those in the chest may also be involved.
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Stage IV: There is evidence of
distant metastases (spread through the bloodstream to other organs).
TNM Staging System
Another staging system has recently been developed by the International
Mesothelioma Interest Group and adopted by the American Joint Committee on
Cancer (AJCC). This is a TNM system, similar to staging systems used for most
other cancers. T stands for tumor (its size and how far it has spread to
nearby organs), N stands for spread to lymph nodes and M is for
metastasis (spread to distant organs). In TNM staging, information about the
tumor, lymph nodes, and metastasis is combined in a process called stage
grouping to assign a stage described by Roman numerals from I to IV. Major
cancer centers are beginning to use this system instead of the Butchart staging
because it more accurately depicts the extent of tumor.
- Stage I: Mesothelioma involves either the right or left pleura lining the chest. It has
only spread to the outer lining of the lung in, at most, a few small spots. It
has not yet spread to the lymph nodes.
- Stage II:
Mesothelioma involves either the right or left pleura lining the chest and has
spread from the lining of the chest into 1) the outer lining of the lung or 2)
the diaphragm or 3) into the lung itself.
- Stage III:
Mesothelioma involves either the right or left pleura lining the chest and has
spread into 1) the first layer of the chest wall, or 2) the fatty part of the
mediastinum, or 3) a single place in the chest wall or 4) the outer covering
layer of the heart or 5) lymph nodes anywhere in the same side of the chest.
- Stage IV:
Mesothelioma involves either the right or left pleura lining the chest and has
spread 1) into the chest wall, either muscle or ribs, or 2) through the
diaphragm, or 3) into any organ contained in the mediastinum (esophagus,
trachea, thymus, blood vessels), or 4) into the spine, or 5) across to the
pleura on the other side of the chest, or 6) through the heart lining or into
the heart itself, or 7) into the brachial plexus (nerves leading to the arm), or
8) into lymph nodes outside that side of the chest, or 9) spread to other organs
through the bloodstream.
The Brigham System
The Brigham System is the latest system and stages mesothelioma according to
resectability (the ability to surgically remove) and lymph node involvement.
Your doctors may utilize one or more of the
above staging systems to evaluate the extent of the mesothelioma, and identify
appropriate treatment options. Click
Here to learn more about available treatment procedures.
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