Mesothelioma Stages: Classifying Cancer in 4 Stages.
Doctors use four primary stages to determine the seriousness of a diagnosis of mesothelioma. These mesothelioma stages determine the extent of cancer within the body. There are four stages. Stage l, ll, lll, or lV. A lower number means you have more treatment options and a better chance for long-term survival.
Doctors use these mesothelioma stages to describe the cancer to patients and to one another about how advanced the cancer is, how many tumors there are and how far the cancer has spread within the body. It is an important assessment tool because once the doctor knows the stage of cancer, he can then develop a table for treatment. He will know which treatments are available and which are not.
Aggressive treatment is given when a doctor believes that a patient is healthy enough and that all signs of cancer can be removed completely (mesothelioma stages I and usually stage II as well). If the cancer has spread and cannot be removed completely, the cancer is considered unresectable (mesothelioma stages IV and sometimes stage III). The doctors will recommend treatment options such as chemotherapy and experimental treatments which can stop the spreading of the cancer and reduce tumor size.
Mesothelioma stages are methods that vary from Doctor to Doctor. Mesothelioma Doctor’s do not all agree on one staging system but they do agree staging is a good predictor of life expectancy.
Deeper look into the Mesothelioma stages
The least serious stage is stage l. It usually has the highest survival rate because there are curative surgical treatments available. The majority of patients in stage l qualify for extrapleural pneumonectomy which is an aggressive surgery. This surgery attempts to remove the tumor and as much of its growth as possible. Surgeons may remove an entire lung and other diseased tissues, including nearby lymph nodes, the diaphragm and the linings of the chest and heart. Stage l means there is no lymph node involvement.
Once the cancer has progressed to stage ll, the tumor has become larger and it has invaded the diaphragm or the lung. Lymph nodes may now be involved. Surgical resection may still be possible, but the cancer has most likely spread to both sides of the pleura. At this stage the symptoms for patients are still a bit vague and mild. Patients and sometimes even doctors may mistake the signs of mesothelioma for other illnesses such as the flu. Patients at this stage have likely lost weight but still feel bloated.
In Stage lll, the mesothelioma has now invaded an area of the chest wall or other region such as the esophagus, chest wall or the lymph nodes. At this time surgery is usually ruled out as a beneficial treatment. At this stage patients may have a more difficult time breathing and severe chest pain even when they are resting. Since the tumors have now spread to more parts of the body, pain or discomfort may be felt elsewhere in the body as well.
Now, in stage lV, the mesothelioma has invaded multiple areas of the body including the diaphragm, pericardium, lymph nodes and other organs. The cancer may also be present in the bloodstream, liver, or bones as well. Surgical option is no longer feasible. Approximately 30 percent of patients with this cancer are not diagnosed until stage lV. Patients have a difficult time and breathing and suffer extreme chest pain. Because the tumors often spread to the esophagus or stomach, digestive problems are common and it becomes difficult to eat or swallow. At this point doctors offer chemotherapy, and radiation treatments to extend the life of the patient and provide symptom relief.
Which type of Mesothelioma has a formal staging classification?
As you are well aware of now, Doctor’s will assign cancer a stage of l through lV. The question is, how? What do they use? They will use one of three staging systems and you will read about them in the following paragraph. Stages will vary depending on several factors such as the size and location of the tumor and whether or not it has spread to other organs or the lymph nodes. Other factors include the results of biopsies and imaging tests. The most common mesothelioma is Pleural Mesothelioma, and is the only type of mesothelioma that has a formal staging classification.
The three staging systems for mesothelioma are: Brigham, TNM, and Butchart. These currently do not hold formal staging for other types of cancer so these are primarily used for pleural mesothelioma. TNM and Brigham are used most often by mesothelioma specialists. The general characteristics are similar and indicated below.
Staging Systems for Pleural Mesothelioma
As mentioned before, there are three systems that are used to decide what stage of mesothelioma a patient is in. Each of the systems has either three or four stages with slightly different staging protocols.
Butchart Staging System
This is the most common as well as oldest staging system used for determining the stage of mesothelioma. It focuses on defining where the tuemor is in the body for each stage. It does not address the number of cancer cells present, the size of the tumor or the level of cancer in the body overall.
TNM Staging System
This staging system was developed by the American Joint Committee on Cancer. It is a system used for several different types of cancer. This system considers the characteristics of the tumor, whether or not the lymph nodes are involved and whether the cancer has spread to other areas within the body.
Brigham Staging System
This system also has four stages of progression. The difference in this system is that it assess the likelihood of successful surgery at each stage of mesothelioma in addition to identifying the characteristics of the tumor and whether or not it has spread.
TNM Staging System
Briefly described above, the TNM system. TNM stands for Tumor, Node, Metastasis. Once malignant mesothelioma has been confirmed as a diagnosis, the doctors run tests to check for a possibility of spreading of the cancer cells to other parts of the body. So, in the “TNM” system, a combination of one of the letters and a numbering system are used in the diagnosis. For example:
- T is the letter that associates with the size of the cancerous tumor and how much it has spread to the tissue in the surrounding area. Using 1 as the smallest tumor and 4 being a large tumor. For this example, we will give this patient a 3.
- N is representative of whether the cancer has spread to the lymph nodes. In this system if there are no lymph nodes with cancer cells present, the number would be 0, if there are many, it would be 3. For this example, we will give this patient a 2.
- M is representative of Metastasis, which is a determination of whether or not cancer has spread to another area in the body. A score of 0 is assigned if there is no spreading and 1 if the cancer has spread. For this example, we will give this patient a 0.
For this system and for the example results above, the patient would see a stage result of: “T3 N2 M0.” This conveys specifics of a relatively large tumor, with mild to severe lymph node affections, but is still localized and has yet to spread towards other parts of the body.
- How is Malignant Mesothelioma Staged?. American Cancer Society. Retrieved From: http://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-staging.Accessed 6/14/16.
- Gutman, H. (2011). Lung Cancer and Mesothelioma Ebook. Xlibris
- Galateau-Sallé, F. (2005). Pathology of Malignant Mesothelioma Longer. Springer-Verlag.
- Mesothelioma: Tests and diagnosis.. Mayo Clinic.. Retrieved From: http://www.mayoclinic.com/health/mesothelioma/DS00779/DSECTION=tests-and-diagnosis.Accessed 6/14/16.
- Mesothelioma Workup – Staging. Medscape Reference.. Retrieved From: http://emedicine.medscape.com/article/280367-workup#aw2aab6b5b4. Accessed 6/14/16.
- Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura: experience with 29 patients. Thorax. 1976;31:15-24.
- Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, ed. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer-Verlag;2010.
- Flores RM, Rush VW. Staging of Mesothelioma. In: Pass HI, Vogelzang N, Carbone M, ed. Malignant Mesothelioma: Pathogenesis, Diagnosis, and Translational Therapies. New York, NY: Springer; 2005:402-415.
- Sugarbaker DJ, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999 Jan;117(1):54-63; discussion 63-5.
- Chahinian, A., and Robinson, B. Mesothelioma. Martin Dunitz: London. 2002.
- Vanderbilt University Medical Center. (2012). Department of Thoracic Surgery – Mesothelioma. Retrieved fromhttp://www.mc.vanderbilt.edu/root/vumc.php?site=thoracic&doc=3594
- American College of Chest Physicians. (1995). A Proposed New International TNM Staging System for Malignant Pleural Mesothelioma. Retrieved from chestjournal.chestpubs.org/content/108/4/1122
- Baldi, A. (Ed.). (2008). Mesothelioma from bedside to clinic. New York, NY: Nova Science Publishers, Inc.
- Dodson, R.F., & Hammar, S. P. (Eds.). (2006). Asbestos: Risk assessment, epidemiology, and health effects. Boca Raton, FL: Taylor & Francis Group.
- National Cancer Institute. (2015, January 6). Cancer Staging. Retrieved fromhttp://www.cancer.gov/cancertopics/factsheet/detection/staging
- O’Bryne, K., & Rusch, V. (Eds.). (2006). Malignant pleural mesothelioma. New York, NY: Oxford University Press.
- Pass, H., Vogelzang, N. and Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: 2005.
- American Cancer Society. (2015, May 18). Treatment of Mesothelioma Based on the Extent of the Cancer. Retrieved fromhttp://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-treating-by-extent
- NYU Langone Medical Center. (n.d.). Is Your Patient a Candidate? Retrieved from http://hipec.med.nyu.edu/physicians/your-patient-candidate