Mesothelioma Staging - Stage 4

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Staging is the process of finding out how far the mesothelioma has spread. It is based on imaging studies such as x-rays, CT scans, and MRI scans. The type of mesothelioma treatment and the prognosis for the patient depends on the stage 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.

There are several staging systems currently being used for malignant mesothelioma. The staging systems 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 the four stages and it is still currently being used by many specialists in the field. The Brigham Staging System also uses 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.

There are four mesothelioma stages Stage I, Stage II, Stage III and Stage IV.

Peritoneal Mesothelioma Stage IV mesothelioma, the most advanced and final stage of mesothelioma, means that the disease may have spread to the chest wall and to the diaphragm, as well as 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. It has also spread into the lymph nodes on the opposite side of the body, above the collarbones, or to other parts of the body.

Individuals with stage IV mesothelioma are in a stage of the disease that is considered inoperable. There are a number of treatments and procedures available for stage 4 mesothelioma patients, which may help to alleviate symptoms. Treatments and procedures may include surgery, chemotherapy, radiation, or a combination of the three (multimodality), along with supportive care. Patients with stage IV mesothelioma may also be eligible to enroll in promising clinical trials. Clinical trials utilize new and innovative therapies that could possibly provide better treatment and outcomes than current treatments.

Although rare, surgery is still a possibility for patients diagnosed with stage IV mesothelioma. It rare cases, it may be used to remove the affected pleura to help improve breathing. Many researchers also believe that debulking (removal of as much of the tumor as possible) may improve the results of chemotherapy.

TNM Staging System

Stage IV (T4, any N, M0; OR any T, N3, M0; OR any T, any N, M1): Mesothelioma involves the pleura on either side of the chest and has spread into the chest wall, either ribs or muscle, through the diaphragm, into any organ in the mediastinum, into the spine, to the other side of the chest, through lining of the heart lining or into the heart, or into the brachial plexus. The cancer may or may not have spread to lymph nodes in any part of the body, and it has not spread to other parts of the body, or the tumor may be of any size and has spread to lymph nodes in the collarbone area, to mediastinal or hilar lymph nodes, but has spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side of the chest opposite the affected lung, but has not spread to other parts of the body, or it has spread to other parts of the body.

Butchart Staging System

Stage IV: The cancer has spread to other parts of the body, or to the bloodstream.

Brigham Staging System

Stage IV: The disease has metastasized into other parts of the body.

Once the stage, type of mesothelioma, and overall health of the patient have been determined, the doctor will explore the various treatment methods.

'Mesothelioma Staging - Stage 4' Resources:
  1. "Mesothelioma Data, Information & Statistics", http://www.mesothelioma-data.com/ (online fact sheet) 2007
    Accessed: 3/6/08.
  2. "Stages of Malignant Mesothelioma" (online article) 2/12/08
    Accessed: 3/6/08.
  3. "Malignant Mesothelioma Treatment – Stages of Malignant Mesothelioma", http://www.webmd.com/cancer/tc/mesothelioma-treatment-
    patient-information-nci-pdq-stages-of-malignant-mesothelioma (online article) 8/2/07
    Accessed: 3/6/08.

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