The 4 Stages of Mesothelioma.

Stages of Mesothelioma

When patients are diagnosed with mesothelioma, physicians place the disease into different stages according to its development. This allows doctors to understand how advanced the cancer is and in turn decide what the patient’s prognosis is. According to the National Cancer Institute (NCI), there are currently four stages of mesothelioma, with the latter stages being the most severe.

A staging system known as the TNM Classification of Malignant Tumors (TNM) was created in the 1990s’ to help doctors in evaluating which stage of disease the mesothelioma patient is in. Although there are other accepted staging systems, the TNM staging system is the most widely accepted and used by mesothelioma doctors. It helps classify the following stages:

Stage I: Localized

Stage I is the first stage of mesothelioma. It’s broken up into either Stage IA or Stage IB. At this point, the cancer is still localized and patients have the best chances of successful treatment.

Stage IA is diagnosed when the cancer is located in either the lining of one side of the chest wall or the lining of the chest cavity, between the lungs. At this stage, the cancer has not yet spread from these points in the body.

Stage IB is diagnosed when the cancer is found in both the lining of the chest walls as well as the lining of the chest cavity. Again, the cancer has not yet spread from these points.

Stage II: The First Advanced Stage

When patients are in Stage II, the cancer is no longer localized and they are now in the first phase of the advanced stage of the disease. During this stage, the cancer is not only in the lining of the chest wall and chest cavity, but also in the lining that protects the lungs and the diaphragm. Keep in mind, however, that the cancer can be in the lining of either the lungs, the lining of the diaphragm, or both.

Stage III: Advanced

During Stage III, cancer is found in the lining of one side of the chest wall, and may have also spread to the the chest cavity lining, the diaphragm lining, and the lung lining. Cancer has now spread to the lymph nodes, close to the victim’s esophagus and trachea.

Stage IV: Advanced

Stage IV is the most advanced stage of the disease and the cancer can no longer be removed. During this stage, the cancer is found in one or more of the following areas in the body:

    The peritoneum via the diaphragm

    Chest tissue lining

    Chest walls

    Center of the chest cavity

    The spine, brain, thyroid, or prostate

    The heart muscle and/or the sac surrounding the heart

Resectable and Unresectable Cancer

As previously mentioned, the TNM stages the development of mesothelioma so that doctors will have a better understanding of the victim’s prognosis. However, when determining which treatments are best according to each stage, doctors will first figure out if the cancer is resectable or unresectable. If the tumors are resectable, they can be removed. Likewise, if the tumors cannot be removed, they are considered unresectable.

In most cases, the first three stages of mesothelioma are considered resectable. However,  there are always a few exceptions. For example, the subtype of the cancer along with how far it has grown into the body’s tissues will determine if it can be removed. Additionally, the patient’s health is taken into consideration. Unhealthy people generally are not candidates for surgery and removal.

Other Staging Charts

Although, as aforementioned, the TNM staging is the most widely-used staging systems by most physicians, other charts have also been helpful in diagnosing stages of mesothelioma, including:

The Brigham System

Created by Dr. David Sugarbaker, one the leading mesothelioma physicians at the Brigham and Women’s Hospital at Harvard, the Brigham System uses both clinical and radiological advances to find the development of the disease and the diagnosis. Similar to TNM staging, the Brigham System utilizes four stages to determine the cancer development:

Stage I: Lymph nodes are not involved during this stage and the cancer is only in the pleural area.

Stage II: The cancer is still locked in the pleural area but may have also spread to the lymph nodes.

Stage III: The cancer has now transferred into the diaphragm, structures in the thorax, or the diaphragm.

Stage IV: The cancer has spread to various parts of the body and is now considered unresectable.

The Butchart Staging System

The Butchart staging system is the original staging system used to stage pleural mesothelioma. As with other systems, the Butchart staging system classifies mesothelioma in four stages, with the final stage being the most severe. This particular staging system was created in 1979 by Dr. Eric Butchart, a cardiothoracic surgeon at the University Hospital in Wales, United Kingdom. Dr. Butchart created the staging system as a means to determine which mesothelioma patients were ideal candidates for different types of treatments. In general, patients in stage I or II were good candidates for curative treatments while patients in stage III or IV were good candidates for palliative treatments.

Stage I: The cancer is on one side of the lining of the lungs or one side of the lining of the heart.

Stage II: Tumors are now on both sides of the lining of the lungs in addition to either the chest wall, heart, or esophagus. Mesothelioma cells have also reached the lymph nodes. Radiation therapy is advised during this stage as long as the patient is healthy enough.

Stage III: Tumors have invaded either the lining of the stomach or the diaphragm. In addition, the mesothelioma cells have now made their way outside of the chest and into the lymph nodes. Dr. Butchart suggests cytotoxic drugs in combination with drainage via tubes during this stage.

Stage IV: Tumors have now transferred across the body and into the patient’s bloodstream. They can be found in several of the body organs, including the liver, brain, and even the bones. At this point, Dr. Butchart advises palliative mesothelioma treatment only as the tumors are too advanced to be removed.

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