Brigham Staging System for Mesothelioma

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Accurate diagnosis of the type of mesothelioma as well mesothelioma staging is necessary in order to create the most effective treatment plan for patients suffering from a mesothelioma diagnosis.

Mesothelioma staging is a process that is used to determine if the mesothelioma, a rare form of asbestos cancer, has spread outside the pleura or peritoneum and just how far the disease has spread outside the pleura or peritoneum. Doctors can create the very best treatment plan once the stage of severity of the mesothelioma is determined.

There are several staging systems currently being used to determine whether patient’s are in the early or advanced stages of mesothelioma. The staging systems include: the TNM Staging System, the Butchart Staging System, and the Brigham Staging System.

The Brigham staging system is newest staging system for malignant mesothelioma. Fifty-two patients were treated with trimodality therapy at the Dana-Farber Cancer Institute/Brigham and Women’s Hospital Thoracic Oncology Program in Boston Massachusetts. The Brigham staging system was introduced shortly after analyzing these patients. The Brigham staging system allows for four stages and it is based on whether the mesothelioma can be treated or removed by surgery. It is also based on whether or not the body’s lymph nodes are involved. The Brigham stages are similar to the TNM system.

Stage I

Stage I mesothelioma using the Brigham staging system means that the mesothelioma is still resectable or able to be removed by surgery. In this earliest stage, the lymph nodes have not been affected.

Stage II

Stage II mesothelioma using the Brigham staging system means that the mesothelioma is still respectable (able to be removed by surgery), but the body’s lymph nodes have been affected.

Stage III

Stage III mesothelioma using the Brigham staging system means that the mesothelioma is not resectable (able to be removed by surgery) and that is has penetrated the abdominal cavity, the chest wall, the heart or the diaphragm. The body’s lymph nodes may or may not be affected.

Stage IV

Stage IV mesothelioma using the Brigham staging system means that the mesothelioma has completely metastasized or spread beyond its original site.

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 to determine the type of mesothelioma (IE: Is it the most common form of the disease, pleural mesothelioma, or is it a much more rare form such as pericardial mesothelioma?). 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.

Once the stage of the mesothelioma has been determined as well as an assessment of any other medical conditions the patient may have and the patient’s overall body and organ health, the doctor will explore the various treatment methods. The treatments and methods used for mesothelioma treatment can be divided into two types: traditional mesothelioma treatments and new mesothelioma treatments. Traditional mesothelioma treatments include: surgery (pleurectomy/decortication or P/D, extrapleural pneumonectomy, pleurodesis, peritonectomy), chemotherapy (anti-cancer drugs, which are usually injected into a vein), and radiation therapy or radiotherapy.

Radiation therapy or radiotherapy involves the use of high-energy rays to shrink tumors and kill cancer cells, but it only affects the cancer cells in the treated area only. There are two types of radiotherapy including external radiation and internal radiation therapy. External radiation is generated through a machine and internal radiation therapy is delivered directly to the source of the cancer by placing radioactive materials into the body through small tubes. In many cases a trimodal approach is employed, which means several treatments are combined for the best outcomes, for a better chance at long-term survival, and/or a better quality of life.

Mesothelioma Treatment OptionsNew mesothelioma treatments include gene therapy, photodynamic therapy or PDT, immunotherapy, intensity modulated radiation therapy or IMRT, and the development of new chemotherapy agents. In addition to these new (or radical) mesothelioma treatments, there are several other radical treatments available including angiogenesis therapies, antineoplaston therapy, mesothelioma clinical trials, interferon and interleukin therapy, and radiofrequency ablation. A wide variety of complementary and alternative mesothelioma treatments also exist such as herbal products, special diets, homeopathic medicine, acupuncture, therapeutic massage, high dose vitamin C, laetrile (amygdalin, extracted from fruit pits), and Eastern medicines. IMRT

Following is a brief description of the TNM Staging System and the Butchart Staging System. The TNM staging system was created by the American Joint Committee on Cancer (AJCC). The TNM staging system is considered the major staging system. T stands for tumor and it refers to the tumor size and how far it has spread to nearby organs; N stands for “spread to lymph nodes,” and M stands for Metastasis. This means whether the mesothelioma has spread to other (distant) organs. The TNM Staging System assigns categories and numbers to determine the overall mesothelioma stage.

The Butchart staging system was created by M.D., and cardiothoracic surgeon Eric G. Butchart. It is the oldest of all staging systems and it is based on the magnitude of the primary tumor mass. While the Butchart staging system has been around since the 1970’s, it is still currently being used by many specialists for its advantage of simplicity and relevance to prognosis and therapeutic options.