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There are 3 main staging systems for mesothelioma:
Staging is a way of describing a cancer, such as where it is located, where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancers.
Butchart Staging System
Butchart is based mainly on the extent of the primary tumor mass, and divides mesotheliomas into stages I through IV.
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.
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.
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.
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 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. Minor differences exist between the AJCC TNM staging system and the Butchart staging system.
Stage I: The tumor has invaded the ipsilateral parietal pleura, with or without involvement of the visceral pleura, and has not spread to the lymph nodes or other parts of the body (T1, N0, M0).
Stage IA: The tumor has invaded the ipsilateral parietal pleura, without involvement of the visceral pleura, and has not spread to the lymph nodes or other parts of the body (T1a, N0, M0).
Stage IB: The tumor has invaded the ipsilateral parietal pleura, with involvement of the visceral pleura, and has not spread to the lymph nodes or other parts of the body (T2a, N0, M0).
Stage II: The tumor has invaded any of the ipsilateral pleural surfaces with at least one of the following: visceral pleural tumor, invasion of the diaphragmatic muscle, or invasion of the lung. The cancer has not spread to the lymph nodes or throughout the body (T2, N0, M0).
Stage III: The cancer has invaded any of the ipsilateral pleural surfaces with at least one of the following: visceral pleural tumor, invasion of the diaphragmatic muscle, or invasion of the lung; or the tumor involves any of the ipsilateral pleural surfaces, with at least one of the following: invasion of the endothoracic fascia (the membrane that surrounds the thorax), invasion into mediastinal fat with spread to the lymph nodes, but not to distant parts of the body. The cancer has also spread to the lymph nodes, but not throughout the body (T1 or T2, N1, M0; T1 or T2, N2, M0; T3, any N, M0).
Stage IV: The cancer involves any of the ipsilateral pleural surfaces, with at least one of the following: diffuse or multifocal invasion of soft tissues of the chest wall, any involvement of rib, invasion through the diaphragm to the peritoneum, invasion of any mediastinal organ(s), direct extension to the contralateral pleura, invasion into the spine, extension to the internal surface of the pericardium, pericardial effusion with positive cytology, invasion of the myocardium, and/or invasion of the brachial plexus. Stage IV can also mean that the tumor is of any size and the cancer has spread to distant lymph nodes, or the cancer has spread to other parts of the body(T4, Any N, M0; any T, N3, M0; or any T, any N, M1).
Recurrent: This is cancer that has come back after treatment. It may return in the chest or in another part of the body.
Brigham Staging System
The Brigham staging system was introduced after analyzing the first 52 patients treated with trimodality therapy at the Dana-Farber Cancer Institute/Brigham and Women's Hospital Thoracic Oncology Program. This staging scheme allows four stages and considers resectability and nodal status. Patients with stage I disease have resectable tumors with no affected lymph nodes. Stage II refers to resectable tumors accompanied by positive lymph nodes. Stage III includes tumors that are unresectable due to local extension into mediastinal structures or through the confines of the diaphragm. Stage IV describes metastatic disease.
Brighan staging system, on the other hand, determines whether the Mesothelioma can be surgically removed or not and whether the lymph nodes are affected or not. In stage I Mesothelioma, the lymph nodes are not yet affected and the patient can still recover through surgery. In stage II, surgery can still be executed but some lymph nodes have already been infiltrated by the cancer cells.
In stage III, the heart and chest wall are already affected; thus, surgery is no longer advisable. The lymph nodes in this stage, however, may or may not be affected. In the final stage, stage IV Mesothelioma, cancer cells have already gone to the bloodstream and other parts of the body like the heart, brain, bone and liver. In most cases, a patient who has reached stage IV Mesothelioma only has four to twenty-four months to live.
The major purpose of staging in MPM is to identify patients who might benefit from surgery. The emphasis of the International Mesothelioma Interest Group (IMIG) staging system is therefore on early disease. The survivals of patients with stages higher than stage I is equally dismal. Parietal plaques only (T1a) or if accompanied by minimal local involvement of the visceral pleura (T1b) constitute T1 and stage I (SI).
Confluent involvement of the parietal pleura including fissures, with or without lung involvement or diaphragmatic muscle involvement constitutes T2 and SII. Invasion into the endothoracic fascia or mediastinal fat, resectable chest wall involvement and nontransmural involvement of the pericardium defines T3 and Stage III (alternatively triggered by hilar lymph nodes positive for cancer - N1 or ipsilateral mediastinal lymphadenopathy - N2). More advanced disease that is all patients with T4 or N3 or M1 have stage IV disease.
Mesothelioma stages determine if the cancer has spread from the original location to the other parts of the body. Mesothelioma staging could be clinical or pathological. Clinical staging depends on scanning tests and x-rays whereas pathological staging refers to staging done at surgery. Note that plural mesothelioma is the only mesothelioma that has staging system.
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