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The Staging System of Mesothelioma

Diagnosis of this rare form of lung cancer is difficult. Mesothelioma is caused by prolonged exposure to asbestos but the symptoms may not show up for thirty to forty years later.

To help with deciding on proper diagnosis and treatment, staging systems are used. Staging means to identify how far the cancer has spread through the body, and what stage it is at. Imaging tests like x-rays, CT scans and MRI scans are used to determine the ‘stage’ of the cancer. Pleural mesothelioma, the most common and therefore the easiest to study is the only mesothelioma that uses a staging system.

The Buchart system, divides the cancer into stages I to IV, based on the size of the tumor.

Stage I – mesothelioma is present in the left or right pleura and might involve lungs, pericardium and/or the diaphragm on the same side of the body.
Stage II – the mesothelioma has entered the chest wall or already involves the esophagus, heart, lymph nodes or pleura on both sides.
Stage III – the mesothelioma has entered the peritoneum and lymph nodes outside the chest could be involved.
Stage IV – the mesothelioma has spread through the bloodstream to other organs.

A second staging system was developed by the American Joint Committee on Cancer. It’s called a TNM system and is similar to staging systems used on different cancers.

Stage I - mesothelioma is present in the right or left pleura. It may have spread into the lung, pericardium or the diaphragm on the same side. The lymph nodes are not involved.
Stage II – the disease has spread from the pleura on one side to the nearby peribronchial and/or hilar lymph nodes close to the lungs on the same side. It could also have spread to the lung, pericardium or the diaphragm on the same side.
Stage III – the disease has gone into the muscles of the chest wall, ribs, heart, esophagus or other organs in the chest on the same side with/without having spread to lymph nodes.
Stage IV - at this point, the mesothelioma has spread into the lymph nodes in the chest on the opposite side to the main tumor, or has spread to the pleura or lung on the opposite side and/or has spread to the peritoneum or abdominal cavity and organs.

There is a third system, the Brigham system. These stages are based on the ability to surgically remove the tumor and the extent of involvement of the lymph nodes.

Stage I – mesothelioma is able to be remove, and there are no lymph nodes involved.
Stage II – mesothelioma can be removed but there is lymph node involvement.
Stage III – there is presence of mesothelioma that can’t be surgically removed that extends into the chest wall, heart or through the diaphragm or peritoneum.
Stage IV – the cancer has spread throughout the body.

Each of these systems help the physicians to diagnose and treat mesothelioma patients.