There are four primary stages of mesothelioma doctors
use to identify the seriousness of a mesothelioma diagnosis.
Mesothelioma staging is labeled I, II, III or IV. The lower the number,
the more treatment options you have, and the better your chances are for
long-term survival.
Staging is an accepted way for cancer doctors to describe to
patients – and to one another – how advanced the disease is, how
prevalent tumors are and how far the cancer has spread. Given the
aggressive nature of the cancer, mesothelioma staging is a key part of
proper diagnosis and treatment.
Why? Because knowing where a cancer is in its development
sets the table for treatment, what's possible and what's not. Doctors
determine if someone can have surgery and, if so, what kind.
Early Detection is Vital
The stage of cancer is vital information for oncologists (cancer
doctors) who treat mesothelioma. All experts agree universally on one
principle: It's preferable to catch a cancer in the earliest possible
stage.
Staging Methods Vary
Many specialists who treat these cancers — even some of the
most respected ones in the field — don't agree on one staging system.
Although many doctors agree that staging is a strong predictor of
lifespan, not all do.
Getting A Second Opinion
If you are diagnosed with mesothelioma, you should seek a
second opinion. Oncologists treat a variety of cancers, but they may not
have experience with staging asbestos-related cancers. In those cases,
find a doctor who does.
Stages of Cancer and What They Mean
Using one of three systems, doctors will assign your cancer a stage
of I through IV. The stage varies depending on several factors,
including the size and stage of your tumor and whether it has spread to
lymph nodes or distant organs.
There are Three Main Staging Systems
- Brigham
- TNM
- Butchart
Doctors use these systems primarily for pleural mesothelioma staging
because there are currently no formal staging systems for the other
types. TNM and Brigham are the most-used by mesothelioma specialists,
although some doctors believe that none are accurate enough.
Stage I Is the Least Serious
Stage I typically offers the best chance for survival because of
the potentially curative surgical treatments available for patients.
Most stage I patients qualify for extrapleural pneumonectomy, an
aggressive surgery that attempts to remove as much of the tumor growth
as possible. Surgeons take out an entire diseased lung and other
tissues, including the diaphragm, nearby lymph nodes and the linings of
the chest and heart.
Stage IV Is the Most Serious
At
this stage of progression, most doctors only recommend
palliative treatments because the cancer has spread to many parts of the
body. Trying to remove all the tumors is too difficult, and many
patients are too weak to withstand aggressive treatments. Palliative
treatments, which focus on symptoms rather than curing the disease, can
ease pain and suffering and improve quality of life.
Because of the nature of mesothelioma and the way the cancer grows
and spreads, most people are not diagnosed until stage III or IV.
Doctors usually treat asbestos-related cancers with a combination of
chemotherapy, radiotherapy and surgery. Depending on the progression and
location of cancer cells, they may recommend different options.
-
Stage I
At this point of early development, tumors are close to the original tumor, having only grown in one layer of the lining of the lungs (pleura). The cancer may also have grown into the covering of the heart and the diaphragm on the same side as it first formed.
The life expectancy for someone with stage I mesothelioma is significantly better that those with later stages, and these patients may live three years or longer. However, it is difficult to catch the cancer this early because people with this stage do not usually have symptoms.
Curative surgery to remove the tumor is considered the first line of treatment, and doctors usually recommend aggressive treatment that includes chemotherapy and radiotherapy.
The cancer is localized and surgery is most effective.
The survival rate is highest at stage I. -
Stage II
Stage II symptoms are vague and mild. Patients — and even doctors — sometimes mistake them for signs of other illnesses like the flu. Patients with peritoneal mesothelioma may lose weight and yet feel bloated.
Several treatment options are available, and doctors can usually offer curative surgery to remove tumors. In studies, some patients diagnosed at this point survive for years.
The cancer has started to spread. Surgery is still an option and the survival rate is close to that of stage I. -
Stage III
Once the cancer progresses to stage III, it may have spread to several locations on the same side of the body as it formed. These areas may include the lymph nodes, esophagus, muscles, ribs, heart and the chest wall.Pleural mesothelioma patients may suffer from more difficulty breathing and intense chest pain even when resting. Peritoneal mesothelioma usually involves some type of bowel obstruction and pain. Because the tumors have now spread to multiple areas of the body, discomfort may be felt in other parts of the body as well.Tumors typically do not respond to potentially curative treatment, and some stage III cancer patients will find themselves ineligible for surgery. At that point, doctors offer palliative options.Life expectancy is significantly shortened for patients at this point, and survival outlook is typically less than a year.Stage IV
About 30 percent of mesothelioma patients are not diagnosed until this stage. By stage IV, tumors have metastasized (spread) throughout the body via the bloodstream and could be present on the liver, in the brain, bones or elsewhere.Patients experience extreme difficulty breathing and suffer from severe chest pain. Tumors can spread to the esophagus or stomach, causing digestive problems and difficulty swallowing or eating.
Doctor's don't recommend aggressive surgeries. Instead, they fall back on palliative treatments designed to ease pain and control symptoms.
The average life expectancy for patients diagnosed so late is about six months.
| Medical Definitions | |
|---|---|
| Parietal pleura: | The lining of the chest cavity |
| Visceral pleura: | The lining of the lungs |
| Lung parenchyma: | Any form of lung tissue, including the bronchioles, bronchi, alveoli, interstitium and blood vessels |
| Mediastinal: | Affecting the mediastinum, the area between the lungs containing the heart, aorta, trachea esophagus and thymus |
| Diaphragmatic pleura: | The lining of the diaphragm, a primary breathing muscle |
| Peritoneum: | The lining of the abdominal cavity |
| Endothoracic fascia: | A layer of connective tissue that separates the ribs from the pleura |
| Pericardium: | The lining of the heart |
| Myocardium: | The muscle tissue of the heart |
| Diffuse: | Spread across a wide area |
| Multifocal: | Occurring in more than one location |
| Unresectable: | Not capable of being removed with surgery |
| Nontransmural: | Occurring not completely, but partially across the wall of an organ |
| Ipsilateral: | On the same side of the chest as where the cancer formed |
| Contralateral: | On the opposite side of the chest as where the cancer formed |
Brigham Staging System
The Brigham staging system was created by Dr. David Sugarbaker at the Brigham and Women’s Hospital in Boston. With this system, doctors examine organs, tissues and other structures to learn how far the cancer has advanced.
Brigham System
Stage I
Tumors are confined to the lining of the lungs and cancer has not spread to the lymph nodes.
Stage II
Tumors are confined to the lining of the lungs. Either the intraparenchymal or mediastinal lymph nodes are cancerous.
Stage III
Aggressive and unresectable tumors in the lining
of the lungs have spread into the mediastinum or invaded the chest wall,
diaphragm or contralateral lymph nodes.
Stage IV
Cancer has spread to other parts of the body and is unresectable.
TNM Staging System
Doctors use the TNM system to stage many different types of
cancer. In 1995, the International Mesothelioma Interest Group (IMIG)
modified this system specifically for asbestos-related cancers because
of the lack of a universally accepted staging system.
Also called the IMIG Staging System, this is the most widely used
system for someone with pleural cancer. Doctors sometimes use it for
other types as well. Earlier staging systems like the Butchart system
and Brigham system were based largely on studies of patients who
underwent extrapleural pneumonectomy.
The abbreviation TNM signifies three different parts of a diagnosis:
(T) describes tumor size and location.
(N) describes whether lymph nodes are affected.
(M) describes whether the tumors metastasized, or spread, to other parts of the body.
Doctors add a number after each letter to describe how far the cancer
has advanced. As tumor size increases and the cancer invades more
structures, the number increases.(N) describes whether lymph nodes are affected.
(M) describes whether the tumors metastasized, or spread, to other parts of the body.
Tumor
T describes the size and location of the tumor:
TX:
The primary tumor cannot be assessed.
T0:
There is no evidence of a primary tumor.
T1a
The tumor is limited
to the ipsilateral parietal pleura as well as the mediastinal and
diaphragmatic pleura. There is no involvement of the visceral pleura.
T1b
The tumor has spread to the ipsilateral parietal and visceral pleura, along with the mediastinal and diaphragmatic pleura.
T2:
The ipsilateral
pleural surfaces, which include the parietal, mediastinal, diaphragmatic
and visceral pleura, have been invaded by tumors. At least one of the
following features is also included in this stage:
- Involvement of the diaphragm
- Tumor has spread to the visceral pleura and underlying parenchyma of the lung
T3:
The tumor has
expanded locally, but can potentially be removed with surgery. It has
invaded all of the ipsilateral pleural surfaces, which include the
parietal, mediastinal, diaphragmatic and visceral pleura. One or more of
the following features will be displayed:
- Cancer has spread to the endothoracic fascia
- Cancer has spread to mediastinal fat
- Cancer has spread to the soft tissues of the chest wall
- Nontransmural cancer spread to the pericardium
T4:
The tumor is locally
advanced and is unresectable. It has spread to all of the ipsilateral
pleural surfaces including the parietal, mediastinal, diaphragmatic and
visceral pleura. These tumors will also display at least one of the
following features:
- Diffuse cancer spread or multifocal masses on the chest wall, with or without rib destruction
- Cancer has spread to the peritoneum through the diaphragm
- Cancer has spread to the contralateral pleura
- Cancer has spread to one or more organs of the mediastinum
- Cancer has spread to the spine
- Cancer has spread through the internal surface of the pericardium, with or without pericardial effusion
- Cancer has spread to the myocardium
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Aqeel A. Zaman