How is Mesothelioma Cancer Staged?
Staging is the
process of finding out how far the cancer has spread. Staging of
Mesothelioma is based on imaging studies such as x-rays, CT scans, and
MRI scans. The treatment and outlook for patients with Mesothelioma
largely depends on the stage (extent of spread) 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.
The
staging system most often used for Mesothelioma is the Butchart system.
This system is based mainly on the extent of the primary tumor mass,
and divides Mesotheliomas into stages I through IV.
Butchart Staging System
- Stage I: Mesothelioma is present within the right or left pleura, and may also
involve the lung, pericardium, or diaphragm (the muscle separating the
chest from the abdomen) on the same side.
- Stage II: Mesothelioma invades the chest wall or involves the esophagus (food
passage connecting the throat to the stomach), heart, or pleura on both
sides. The lymph nodes in the chest may also be involved.
- Stage III: Mesothelioma has penetrated through the diaphragm into the peritoneum
(lining of the abdominal cavity). Lymph nodes beyond those in the chest
may also be involved.
- Stage IV: There is evidence of distant metastases (spread through the bloodstream to other organs).
Another
staging system has recently been developed by the American Joint
Committee on Cancer (AJCC). This is a TNM system, similar to staging
systems used for most other cancers. T stands for tumor (its size and
how far it has spread to nearby organs), N stands for spread to lymph
nodes and M is for metastasis (spread to distant organs). In TNM
staging, information about the tumor, lymph nodes, and metastasis is
combined in a process called stage grouping to assign a stage described
by Roman numerals from I to IV. Minor differences exist between the
AJCC TNM staging system and the Butchart staging system.
TNM Staging System
- Stage I: Mesothelioma involves the right or left pleura. It may also have spread
into the lung, pericardium, or diaphragm on the same side. It has not
yet spread to the lymph nodes.
- Stage II: Mesothelioma has spread from the pleura on one side to the nearby
peribronchial and/or hilar lymph nodes next to the lung on the same
side. It may also have spread into the lung, pericardium, or diaphragm
on the same side.
- Stage III: Mesothelioma has
spread into the chest wall muscle, ribs, heart, esophagus, or other
organs in the chest on the same side as the primary tumor, with or
without spread to subcarinal and/or mediastinal lymph nodes on the same
side as the main tumor. Subcarinal nodes are located at the point where
the windpipe branches to the left and right lungs. Mediastinal lymph
nodes are located in the space behind the chest bone in front of the
heart. Mesotheliomas with the same extent of local spread as in stage
II that have also spread to subcarinal and/or mediastinal lymph nodes
on the same side are also included in stage III.
- Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side
opposite that of the primary tumor, or directly extends to the pleura
or lung on the opposite side, or directly extends into the peritoneum,
or directly extends into organs in the abdominal cavity or neck. Any
Mesothelioma with evidence of distant metastases (spread to other
organs through the bloodstream) or spread to organs beyond the chest or
abdomen is included in this stage.
Although the recently
developed TNM classification is the most detailed and precise, the
original Butchart staging system is still used most often to describe
the spread of pleural Mesotheliomas. Understanding these staging
systems for Mesothelioma is important both for estimating and better
understanding prognosis, and also for assessing therapeutic options.
Prognostic Factors
Because pleural Mesothelioma has been better studied than Peritoneal Mesothelioma we know more about factors associated with prognosis for pleural
Mesothelioma. Younger age at diagnosis, performance status (functional
status) and absence of weight loss are associated with a more favorable
prognosis.
Mesotheliomas are usually of three different cell
types (histological analysis): 1) epithelial cell type - has the most
favorable prognosis; 2) fibrosarcomatous cell type - carries the worst
prognosis and 3) mixed cell type - has an intermediate prognosis.
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