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Staging of Mesothelioma
Once malignant mesothelioma is found, more tests will be done to find out if cancer cells have
spread to other parts of the body. This is called mesothelioma staging. A doctor needs to know the stage of the cancer to plan
treatment.
Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. The treatment
and outlook for patients with mesothelioma largely depends on the stage (extent of spread) of their cancer. Since pleural
mesothelioma occurs most frequently and has been studied the most, it is the only mesothelioma for which a staging
classification exists. The following stages are used for malignant mesothelioma:
Butchart Staging System
The
staging system most often used 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.
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.
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.
Stage IV: There is evidence of distant metastases (spreading of
cancerous cells via the bloodstream to other organs).
TNM Staging System
Another staging system has recently
been developed 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. Minor differences exist
between the AJCC TNM staging system and the Butchart staging system.
Stage I: Mesothelioma involves the right or left
pleura. It may also have spread into the lung, pericardium, or diaphragm on the same side. It has not yet spread to the lymph
nodes.
Stage II: Mesothelioma has spread from the pleura on one side to the nearby peribronchial and/or hilar lymph
nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
Stage III: Mesothelioma has spread into the chest wall muscle, ribs, heart, esophagus, or other organs in the chest on the
same side as the primary tumor, with or without spread to subcarinal and/or mediastinal lymph nodes on the same side as the
main tumor. Subcarinal nodes are located at the point where the windpipe branches to the left and right lungs. Mediastinal
lymph nodes are located in the space behind the chest bone in front of the heart. Mesotheliomas with the same extent of local
spread as in Stage II that have also spread to subcarinal and/or mediastinal lymph nodes on the same side are also included in
Stage III.
Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite that of the primary
tumor, or directly extends to the pleura or lung on the opposite side, or directly extends into the peritoneum, or directly
extends into organs in the abdominal cavity or neck. Any mesothelioma with evidence of distant metastases (spreading to other
organs via the bloodstream) or spread to organs beyond the chest or abdomen is included in this stage.
Although the
recently developed TNM classification is the most detailed and precise, the original Butchart staging system is still used most
often to describe the spread of pleural mesotheliomas. Understanding these staging systems for mesothelioma is important both
for estimating and better understanding mesothelioma prognosis, and also for assessing therapeutic options.
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