What Are The Staging Systems Of Mesothelioma?
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Share ArticleMesothelioma is staged using one of three systems, as described in the AJCC Cancer Staging Handbook (1).
The Butchart System is based on the primary tumor’s size:
Stage I: Cancer is in the right or left pleura and may affect the diaphragm on that side.
Stage II: The mesothelioma has affected the chest wall or affects the pleura on both sides, the heart and the esophagus. It may also be in lymph nodes in the chest.
Stage III: Mesothelioma has affected the diaphragm and moved into peritoneum. Lymph nodes in areas other than the chest may also be affected.
Stage IV: The cancer has spread to other parts of the body, or to the bloodstream.
The TNM System refers to the size of the primary tumor (T), whether or not the cancer has spread to nearby nodes (N) and whether it has metastasized distantly (M):
T Stages
T1: Mesothelioma has affected pleura on one side. It has spread to the pleura surrounding the lung.
T2: Mesothelioma involves the pleura on either side and also affects the chest lining. It has grown to the outer lining of the lung, into the lung, or into the diaphragm.
T3: Mesothelioma involves the pleura on either side and affects 1) the outside layer of the chest, 2) any place in the chest wall, 3) the fatty area of the mediastinum (the part of the chest that holds organs), or the 4) the outermost layer of the heart.
T4: Mesothelioma involves the pleura on either side and has grown 1) into the chest wall, affecting either ribs or muscle, 2) through the diaphragm, 3) into any organ in the mediastinum, 4) into the spinal column, 5) to the opposite side of the chest, 6) through the lining of the heart, or into the heart itself, or 7) into the brachial plexus.
N Stages
N0: The mesothelioma has not spread to the lymph nodes.
N1: The cancer has spread to the lymph nodes on the same side of the chest as the primary tumor.
N2: The cancer has grown to the lymph nodes, to the place where the windpipe splits to either side, or to lymph nodes in front of the heart and behind the bones of the chest. The lymph nodes that have been impacted are on the same side as the affected lung.
N3: Mesothelioma has grown into the lymph nodes in the area of the collarbone, on either the right or left side, to the mediastinal or hilar lymph nodes (two different types of lymph nodes) on the other side of the chest side opposite the cancerous lung.
M Stages
M0: The cancer has not spread to other areas of the body, or to other organs
M1: The cancer has spread to other parts of the body
This type of staging is completed by combining the T, N and M categories and designating a stage of I, II, III, or IV.
Stage I (T1, N0, M0): Mesothelioma involves either side of the pleura has spread to the outer layer of the lung. It has spread to neither the lymph nodes nor other parts of the body.
Stage II (T2, N0, M0): Mesothelioma involves either the pleura on either side and has grown into 1) the outermost lung lining, 2) into the lung, or the diaphragm. It still has not grown into the lymph nodes or other parts of the body.
Stage III (T1 or 2, N1 or 2, M0; OR T3, N0-2, M0): Mesothelioma involves the pleura on either side of the chest and may or may not have spread from the lining of the chest into 1) the outermost lung lining, 2) into the lung, 3) the diaphragm and has grown into lymph nodes in the chest, on the same side as the primary tumor, and it has not metastasized to other parts of the body,
OR mesothelioma involves the pleura on either side of the chest and has grown into 1) the chest wall's first layer, or 2) a fatty area of the mediastinum, or 3) any part of the chest wall, or 4) the outer layer of the heart. It may or may not have reached the lymph nodes, but it has not reached lymph nodes near the collarbone or on the side of the chest opposite the primary tumor. It has not spread to other parts of the body.
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 1) into the chest wall, either ribs or muscle, 2) through the diaphragm, 3) into any organ in the mediastinum, 4) into the spine, 5) to the other side of the chest, 6) through lining of the heart lining or into the heart, or 7) 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 (2, 3).
The Brigham System stages the cancer based on whether the tumor can be removed by surgery (resected) and whether or not lymph nodes are affected:
Stage I: The mesothelioma is resectable and has not affected any lymph nodes.
Stage II: It is resectable, but lymph nodes are affected
Stage III: It is unresectable and it has spread into chest wall, or heart, through the diaphragm, or into the abdominal cavity. It may or may not have affected lymph nodes beyond the chest.
Stage IV: The disease has metastasized into other parts of the body.
- Cancer Help, UK. "The Stages of Mesothelioma.", http://www.cancerhelp.org.uk/help/default.asp?page=4465, 13 April 2007.
Accessed: 18 July 2007. - National Cancer Institute. "Stages of Malignant Mesothelioma." 22 August 2006.
Accessed: 18 July 2007. - American Cancer Society. "How Is Malignant Mesothelioma Staged?" 19 October 2006.
Accessed: 18 July 2007.
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