Mesothelioma Staging System

Mesothelioma staging systems serve to evaluate the progress of mesothelioma cancer in a patient.  The systems look at the extent to which mesothelioma has developed and the degree to which mesothelioma metastasis has affected other parts of the body.  Metastasis means the spread of cancer to other parts of the body.  Cancer can spread in three ways:  throught the blood stream, through the lymphatic system, and by direct extension.

Malignant mesothelioma staging systems are only used as a measure of the development of pleural mesothelioma since it is the most frequently diagnosed type of the disease and has been the focus of clinical research studies evaluating mesothelioma.  X-rays, CT scans and MRI scans are used in conjunction with surgical biopsies and histopathological examination to determine the staging of pleural mesothelioma.  The treatment and outlook for a given mesothelioma patient are determined by the mesothelioma staging system.

There are three clinical mesothelioma staging systems that are recognized for the evaluation of pleural mesothelioma:  The Butchart System, TNM Staging and The Brigham System.  The TNM systems is the most current system and will be described here.

TNM Staging System

The TNM Staging System is being used by healthcare facilities as a more accurate method for evaluating a mesothelioma diagnosis.  In fact this system is now the standard system.  T stands for tumor (its size and sometimes condition of the tumor), N stands for spread to lymph nodes and M is for metastasis (meaning spread to distant sites in the body).  Information about all three categories is combined in a process called stage grouping. The TNM system of Mesothelioma consists of four stages:

  • Stage I - Mesothelioma has only spread to the outer lining of the lung with, at most, a few small spots. The cancer has not spread to the lymph nodes.
  • Stage II - Mesothelioma has spread from the lining of the chest into:
    1. The outer lining of the lung
    2. The diaphragm
    3. The lung itself
  • Stage III - Mesothelioma has spread into:
    1. The first layer of the chest wall
    2. The outer covering layer of the heart
    3. The lymph nodes
    4. The fatty part of the esophagus
  • Stage IV - Mesothelioma has spread into:
    1. The chest wall, either muscle or ribs
    2. Through the diaphragm
    3. Any organ in the mediastinum (esophagus, trachea and thymus)
    4. The spine
    5. Through the heart lining or in the heart itself
    6. Into the brachial plexus (nerves leading to the arm)
    7. The lymph nodes
    8. Metastases to distant organs

Understanding mesothelioma staging is important for estimating and better understanding a mesothelioma prognosis, and assessing therapeutic options.

For nearly all cancers, treatment options and survival are related to stage, which is generally characterized by the anatomic extent of disease.  On this basis, it is assumed that early detection of cancer, at an earlier stage, may yield better outcomes.  In the 1940s, a generalized staging classification of localized, regional, and distant disease was developed to show long-term trends, and it is still useful. In the more detailed TNM system, which has been periodically modified, the (T)umor size, the status of the lymph (N)odes, and the status of distant (M)etastases are also categorized. These elements are grouped into stages 0, I, II, III, and IV according to their association with survival. In general, larger primary malignant tumors have a higher incidence of metastasis to regional lymph nodes and to distant sites. Stage has such a profound effect on outcome that all randomized treatment trials require the comparison of similar stages in evaluating differences in outcome. Shifts in stage may also herald improved survival and decreased mortality, though stage shift alone does not establish benefit.

Biologic cellular characteristics of cancer, such as grade, hormone sensitivity, and gene overexpression are recognized as important predictors of cancer behaviors. For example, high-grade cancer may be fast growing and quick to metastasize regardless of stage at the time of diagnosis. Therefore, detection of these cancers when small may not affect outcome. Randomized controlled trials with mortality outcomes are necessary to prove screening benefits.

Legal Questions

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