* Mesothelioma Staging
Doctors utilize staging systems to diagnose potential treatment options for patients. Depending on the nature of the cancer, different surgery and chemotherapy options may be available. An internationally accepted staging system allows doctors to explore potential treatment procedures that are more beneficial to the patient.
Because of the need for an internationally accepted staging system, three systems for diagnosing malignant mesothelioma were developed. The majority of doctors tend to use the TNM system.
While these staging systems are used primarily for pleural mesothelioma, there is currently no formal staging system for the other types of this cancer.
Butchart Staging System
The Butchart system was the first staging system developed for mesothelioma. The system is able to determine the severity of any case of mesothelioma regardless of its histologic subtype.
| Stage | Description |
|---|---|
| Stage 1 | The tumor has confined itself within the capsule of the parietal pleura. It has only involved the ipsilateral pleura, lung, pericardium and diaphragm. |
| Stage 2 | The tumor has invaded the chest wall or involved mediastinal structures and affected the lymph nodes in the chest. The esophagus, heart or opposite pleura are affected. |
| Stage 3 | The tumor has penetrated the diaphragm and involved the peritoneum and opposite pleura. The lymph nodes outside of the chest are involved. |
| Stage 4 | The tumors have metastasized into other parts of the body and are now blood-borne. |
TNM Staging System
The abbreviation TNM signifies three different parts of a diagnosis. The TNM system was developed by the International Mesothelioma Interest Group (IMIG) as the International Mesothelioma Staging System. The different parts of the diagnosis include:
- (T) signifies the size of the tumor and location of the tumor.
- (N) describes whether or not lymph nodes have been affected.
- (M) determines whether the tumors have metastasized into other parts of the body.
Tumor
Several different factors determine the stage of the tumor:
| Tumor Classification | Description |
|---|---|
| T1a | The tumor is limited to the ipsilateral parietal pleura as well as the mediastinal and diaphragmatic pleura. However, there is no involvement of the visceral pleura. |
| T1b | The tumor has involved the ipsilateral parietal pleura along with the mediastinal and diaphragmatic pleura. |
| T2 | The ipsilateral pleural surfaces, which include the parietal, mediastinal, diaphragmatic and visceral pleura, have been invaded by the tumors. |
| T3 | The tumor has expanded locally, but is potentially resectable. It has invaded all of the ipsilateral pleural surfaces, which include the parietal, mediastinal, diaphragmatic and visceral pleura. |
| T4 | The tumor is locally advanced and is unresectable. It has involved all of the ipsilateral pleural surfaces including the parietal, mediastinal, diaphragmatic and visceral pleura. |
Nodes
These criteria depict the advancement of the tumor in the lymph nodes:
| Node Classification | Description |
|---|---|
| NX | The regional lymph nodes cannot be assessed. |
| N0 | The tumor has not metastasized into the regional lymph nodes. |
| N1 | Metastases have occurred into the ipsilateral bronchopulmonary or hilar lymph nodes. |
| N2 | The tumor has metastasized into the subcarinal or the ipsilateral mediastinal lymph nodes, which include the ipsilateral internal mammary nodes. |
| N3 | Metastases have occurred in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes. |
Metastasis
The last factor describes whether or not the tumor has metastasized to the other parts of the body.
| Metastasis Classification | Description |
|---|---|
| MX | The presence of metastasis cannot be assessed. |
| M0 | The tumor has not metastasized to other parts of the body. |
| M1 | The presence of metastasis into other parts of the body. |
Brigham System
The Brigham staging system was created by Dr. David Sugarbaker at the Brigham and Women’s Hospital at Harvard. The system takes a pathologic approach to determine the advancement of diagnosis in patients utilizing both a clinical and radiological approach.
| Stage | Description |
|---|---|
| Stage 1 | The tumors are confined to the pleural envelope and do not involve the lymph nodes. |
| Stage 2 | The tumors are confined to the pleural envelope and either the intraparenchymal or mediastinal lymph nodes are affected. |
| Stage 3 | Locally aggressive and unresectable tumors in the pleural envelope have metastasized into the mediastinum or invaded the chest wall, diaphragm or contralateral nodes. |
| Stage 4 | The tumor has metastasized to other parts of the body and is unresectable. |
Mesothelioma Final Stages
Because of the long latency period associated with most mesothelioma cases, the cancer is commonly not diagnosed until its later stages. New diagnostic tests are continually being researched in order to help mesothelioma patients discover the disease at an earlier stage. When mesothelioma is diagnosed in its earliest stages, a wider variety of treatment options are available.
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