An accurate mesothelioma diagnosis of the type and stage of the disease is necessary in order to create an effective treatment plan for mesothelioma patients. Mesothelioma staging is a process that is used to determine if the mesothelioma cancer has spread outside the pleura or peritoneum and just how far the disease has spread. In order to create the very best mesothelioma treatment plan, a patients doctor must determine the stage of severity of the mesothelioma, as well as whether it is the more common pleural mesothelioma, or one of the rarer forms such as pericardial or peritoneal mesothelioma.
There are several staging systems currently being used to determine whether patient’s are in the early or the advanced stages of malignant mesothelioma. The staging systems include: the TNM Staging System, the Brigham Staging System, and the Butchart Staging System.
The Butchart staging system was created by M.D., and cardiothoracic surgeon Eric G. Butchart and it is the oldest of all staging systems used to stage this asbestos cancer. 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.
There are four mesothelioma stages doctors may assign once Butchart staging is complete. They are: stage 1, the earliest stage of the disease, stage 2, stage 3 and stage 4. The stages of mesothelioma treatment are also communicated in the following format: stage I, stage II, stage III and stage IV.
Stage I mesothelioma using the Butchart system means that the mesothelioma is present within the right pleura or left pleura. It may also involve the lung, pericardium, or the diaphragm, which is the muscle that separates the chest from the abdomen, on the same side of the body.
Stage II mesothelioma using the Butchart system means that the mesothelioma has invaded the chest wall or involves the food passage connecting the throat to the stomach – the esophagus, as well as the, heart, or pleura on both sides. The lymph nodes in the patient’s chest may also be involved.
Stage III mesothelioma using the Butchart system means Mesothelioma has now penetrated through the diaphragm into the lining of the abdominal cavity or “peritoneum.” At this point, some lymph nodes beyond those found in the chest may also be involved.
Stage IV mesothelioma using the Butchart system means there is strong evidence to support that cancerous cells have spread to other organs of the body via the bloodstream, called distant metastases.
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.
Once the stage, type of mesothelioma, and overall health of the patient have been determined, the doctor will explore the various treatment methods. The treatments and methods used for treating mesothelioma 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), andradiation 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 trimodality 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.
New 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.
Following is a brief description of the other two mesothelioma staging systems. The TNM Staging System is considered to be 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.
The Brigham staging system also uses 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.