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Mesothelioma Staging
Staging is a
method of evaluating the progress of cancer in a patient. It looks at
the mesothelioma and the extent to which it has developed and its
possible spread to other parts of the body. Since
pleural mesothelioma occurs most frequently and has been studied the
most, it is the only mesothelioma for which a staging classification
exists.
Several medical approaches are utilized to determine the staging of
mesothelioma, including
x-rays, CT scans, and MRI scans. The advancement, extent, and spread
of the cancer determines the stage of the mesothelioma, and determines
the treatment and outlook for the patient.
There are three recognized clinical staging systems for evaluating the
spread and extent of pleural mesothelioma: The Butchart System, TNM
Staging, and the Brigham System. The Butchart System has been the
standard staging method for most cancers, including mesothelioma. The
TNM Staging system is beginning to be used by major cancer centers as a
more accurate method for specifically evaluating mesothelioma. The
Brigham System is one of the latest methods for the staging of
mesothelioma.
Butchart Staging System
The staging system used in the past 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. Many doctors
will still use this 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).
TNM Staging System
Another staging system has recently been developed by the
International Mesothelioma Interest Group and adopted 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. Major cancer
centers are beginning to use this system instead of the Butchart staging
because it more accurately depicts the extent of tumor.
- Stage I: Mesothelioma involves
either the right or left pleura lining the chest. It has only spread
to the outer lining of the lung in, at most, a few small spots. It has
not yet spread to the lymph nodes.
- Stage II: Mesothelioma involves
either the right or left pleura lining the chest and has spread from
the lining of the chest into 1) the outer lining of the lung or 2) the
diaphragm or 3) into the lung itself.
- Stage III: Mesothelioma
involves either the right or left pleura lining the chest and has
spread into 1) the first layer of the chest wall, or 2) the fatty part
of the mediastinum, or 3) a single place in the chest wall or 4) the
outer covering layer of the heart or 5) lymph nodes anywhere in the
same side of the chest.
- Stage IV: Mesothelioma involves
either the right or left pleura lining the chest and has spread 1)
into the chest wall, either muscle or ribs, or 2) through the
diaphragm, or 3) into any organ contained in the mediastinum
(esophagus, trachea, thymus, blood vessels), or 4) into the spine, or
5) across to the pleura on the other side of the chest, or 6) through
the heart lining or into the heart itself, or 7) into the brachial
plexus (nerves leading to the arm), or 8) into lymph nodes outside
that side of the chest, or 9) spread to other organs through the
bloodstream.
The Brigham System
The Brigham System is the latest system and stages mesothelioma
according to resectability (the ability to surgically remove) and lymph
node involvement.
Your doctors may utilize one or more of
the above staging systems to evaluate the extent of the mesothelioma,
and identify appropriate treatment options. |
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