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Stages of Mesothelioma

Determining how far the disease has progressed

As with many other cancers, medical experts define stages of malignancy for mesothelioma.  These stages represent how much the cancer has developed and spread to other parts of the body.  Generally, cancer is more treatable in the early stages.

Sadly, due to the long period of time between asbestos exposure and the development of mesothelioma, its rarity, and sharing symptoms with more common health problems, mesothelioma is often not detected until it is in a much later stage.

Mesothelioma staging systems

Over time, different identification systems for the four stages of mesothelioma have been developed.  These mesothelioma staging systems are recognized as appropriate for pleural mesothelioma.  Because other types of mesothelioma are rarer, they have not been described in similar systems.

The Butchart Staging System

Developed in the 1970s, this is one of the oldest systems still being used for identifying mesothelioma and many other malignancies.  The Butchart Staging System classifies each stage based on the invasiveness of the primary tumor mass:

  • Stage I: The primary tumor mass is present in the right or left pleura and possibly the lung, pericardium, or diaphragm on the same side.
  • Stage II: The primary tumor mass invades the chest wall or esophagus, heart or pleura on both sides, or lymph nodes in the chest involved.
  • Stage III: The primary tumor mass penetrates through the diaphragm into the lining of the abdominal cavity and may involve lymph nodes beyond the chest.
  • Stage IV: There are distant metastases through the bloodstream and other organs.

There is a proposed staging system that is a modification of Butchart.  It is based upon thoracic surgery principles and clinical data.

The TNM Staging System

The TNM Staging System developed by the International Mesothelioma Interest Group, was adopted by the American Joint Committee on Cancer, and is favored by many major cancer centers.  It is called the TNM Staging System because it is classifies stages for each of three dimensions:

  • Tumor size and spread to nearby organs. Tumor stages are categorized from smallest to largest as T1a, T1b, T2, T3, and T4 for tumors
  • Spread to lymph Nodes. Node stages are categorized from NX where lymph node involvement cannot be assessed  and N0 where the tumor has not invaded the lymph nodes to N1, N2, and N3 that identify the extent to which the tumor has invaded the lymph nodes.
  • Metastasis to distant organs. Metastasis stages include MX where metastasis cannot be assessed, M0 where the tumor has not invaded other parts of the body, and M1 where metastasis is present in other parts of the body

This more stringent staging system identifies some cases of mesothelioma as being at a higher stage than under the Butchart System.  The TNM stages have recently been modified and updated by the International Mesothelioma Interest Group.

The Brigham Staging System

Named for Brigham Hospital in Boston, this is a recently developed system that classifies the mesothelioma according to the possibility of surgical removal and lymph node involvement.  In Stages I and II, the tumor can be removed surgically.  In Stage III, the tumor cannot be removed. In Stage IV, the disease has also spread to other parts of the body.

Of course, regardless of the staging system, the effectiveness of treatment is always better in earlier stages.