Mesothelioma Staging - Stage 3

Mesothelioma is divided into four stages including stage 1, stage 2, stage 3 and stage 4 The stages of mesothelioma may also be communicated in the following format: stage I, stage II, stage III and stage IV.

With stage 3 mesothelioma, the disease has spread to the pericardium (the covering of the heart), and the chest wall or the lymph nodes on the same side of the chest. While stage 3 mesothelioma is extremely serious, it is still possible that it can be removed by surgery. According a 2007 issue of Thoracic Surgery News, in some patients with a stage 3 tumor, an R1 resection can be achieved with a type of surgery called pleurectomy/decortication or P/D. It is important to keep in mind that there are many conflicting reports on the outcomes and possibilities surrounding pleurectomy/decortication for stage 3 mesothelioma.

Pleurectomy/decortication is a surgical procedure that involves the opening of the chest in order to remove the tumor from the lung and it involves the removal of the pleura but leaving the lung behind. Again, this procedure has possibilities, but it may not cure patients with stage 3 mesothelioma. It may still help to relieve pain and fluid collection around the pleural effusion (lung.) In some patients, when combined with chemotherapy and radiotherapy, longer term survival is possible. 

In stage 3 mesothelioma, radiotherapy can be given to slow the spread of cancer and to control the symptoms associated with it. It may be administered after fluid has been drained from the lung. Chemotherapy can be used to treat stage 3 mesothelioma in an attempt to slow the spread of cancer and to alleviate symptoms.

It is important to note that it is a possibility that stage 3 mesothelioma patients may only live for an additional six to eight months following surgery, and stage 4 mesothelioma patients may only live for an additional few weeks to a few months, depending on treatment. Stage 2 mesothelioma patients may live another two to four years following treatment, while 50% of stage 1 mesothelioma patients can live for another five years after treatment provided they have received prompt and aggressive mesothelioma treatment.

There are several staging systems currently being used for mesothelioma. They include: the TNM Staging System, the Butchart Staging System, and the Brigham Staging System. The TNM staging system is the major staging system. T =  Tumor and refers to the tumor size and how far it has spread to nearby organs; N = Spread to lymph nodes, and M = Metastasis, whether the mesothelioma has spread to other (distant) organs. The TNM Staging System assigns categories and numbers to determine the overall mesothelioma stage. Of course, mesothelioma patients with lower stage numbers have a better likelihood of recovery from the disease or a better chance at long-term survival.

The Butchart System, the oldest of all staging systems, is based on the magnitude of the primary tumor mass. It divides mesothelioma into four stages and it is still currently being used by many specialists in the field. The Brigham Staging System also divides the mesothelioma into four stages and it is based on whether the mesothelioma can treated or removed by surgery. It is also based on whether or not the body’s lymph nodes are involved.

During the staging process, several tests and procedures may be used including chest x-ray, CAT scan (CT scan), magnetic resonance imaging (MRI) and endoscopic ultrasound. Chest x-ray involves an x-ray of all of the bones and organs inside the chest. A CAT scan is a procedure that takes pictures from different angles of the abdomen and chest. Also called computed tomography, computerized tomography, or computerized axial tomography, CAT scan images are created by a computer linked to an x-ray machine and in some cases a dye may be swallowed or injected making tissues and organs easier to see.

Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), uses a magnet, radio waves, and a computer to create detailed pictures of the abdomen or chest. Endoscopic ultrasound  (EUS) is also called endosonography. It is a procedure that involves the insertion of an endoscope (a thin, tube-like instrument with a light and a lens for viewing) into the body. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off internal tissues or organs. This creates echoes, which form a picture of body tissues. The picture of body tissues is called a sonogram. Endoscopic ultrasound may be used to help guide fine-needle aspiration (FNA) biopsy of the lymph nodes and lung as well as other areas of the body.

Following is a brief description of the other three stages of mesothelioma. Stage 1 mesothelioma, the earliest stage of mesothelioma, is also divided into stages including: 1a and 1b. Stage 1 mesothelioma affects the outer layer of the pleura around the chest wall. It only affects one side of the chest. In stage 1 (1a), the mesothelioma may have grown in the pleural tissue that covers the muscle that separates the thoracic (chest) cavity from the abdomen or the diaphragm. Stage 1 (1b) mesothelioma means that the disease is in the beginning stages of spreading to the inner pleural layer, but it is still on one side of the chest. There are no lymph nodes containing cancer cells in stage 1 mesothelioma.

Stage 2 mesothelioma means that the mesothelioma has enlarged to form a tumor on the pleural tissue around the lungs or it is spreading into the lung tissue or diaphragm and it has spread to both layers of the pleura on only one side of the body. 

Stage 4, the most advanced stage, means the disease may have spread to the chest wall, the diaphragm, into the peritoneum, the pleura on the opposite side of the body, to the chest organs, or through the inner layer of the covering of the heart, the lymph nodes on the opposite side of the body, above the collarbones, or to other parts of the body.

'Mesothelioma Staging - Stage 3' Resources:
  1. Thoracic Surgery News "Survival Similar for Two Mesothelioma Resection Options" (pdf online) 2007
    Accessed: 3/6/08.
  2. “The Stages of Mesothelioma” (online article) 4/13/07
    Accessed: 3/6/08.
  3. “Mesothelioma Stages” (online article) 2007
    Accessed: 3/6/08.