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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.
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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.
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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.
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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. Click
Here to learn more about available treatment procedures.
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