Mesothelioma Staging

There are three systems in use today for mesothelioma staging. They consist of the Butchart Staging System (oldest, but still in use), the TNM Staging System (recent and most widely used today), and the Brigham Staging System (latest system which can check if the mesothelioma is still resectable)

What is Mesothelioma
Mesothelioma is a rare type of cancer that affects the mesothelium (lining surrounding the lungs, abdomen, or heart).

Main Cause of Mesothelioma
The main cause of mesothelioma is direct or indirect asbestos exposure. During asbestos exposure microscopic (unseen by the eye) asbestos fibers enter the body either through inhalation or ingestion, causing healthy body cells to mutate into cancer (mesothelioma) over a period of time.

Different Types of Mesothelioma
Mesothelioma basically is of three types.

— Pleural Mesothelioma
— Peritoneal Mesothelioma
— Pericardial Mesothelioma

Pleural mesothelioma affects the pleura (lining surrounding the lungs). Over 80% of diagnosed mesothelioma is pleural mesothelioma, making it the most common type of mesothelioma.

Peritoneal mesothelioma affects the lining surrounding the stomach. It is not so common with approximately 10 to 20% diagnosed mesothelioma falling into this category.

Pericardial mesothelioma affects the lining surrounding the heart. It is the rarest type of mesothelioma.

Mesothelioma Treatment
Treatments available today for mesothelioma are surgery, radiation, chemotherapy, and a combination of the three.

The most common type of mesothelioma treatment is surgery, followed by radiation therapy, and chemotherapy. If required a combination of these treatments are used.

Choosing Type of Treatment for Mesothelioma
The physician / surgeon will decide on which type of mesothelioma treatment to choose from. This will depend on what type of mesothelioma it is, the patients age and health, and most importantly at what stage the cancer has been diagnosed.

The treatment for mesothelioma patients will mainly depend on the stage of the cancer.

Staging of Mesothelioma
Since the most common type of mesothelioma is pleural mesothelioma, it is the most studied and is the only type of mesothelioma for which there is a staging system.

Once mesothelioma is diagnosed, further tests will be conducted to find out if the cancer cells have spread to other parts of the body, and to what extent. The stage of the cancer must be known for suitable treatment to be started.

Different systems are in use for mesothelioma staging which consist of the following.

— Butchart Staging System
— TNM Staging System
— Brigham Staging System

Butchart Staging System
The Butchart system is the oldest and was the most commonly used staging system for mesothelioma. It is based on the extent of the primary tumor mass and divides the cancer into four stages; stages I through IV.

Stage I (Butchart System)
In stage I, cancer (mesothelioma) cells are present in the right or left pleura and at times also in the lung, pericardium, or the muscle separating the chest from the abdomen (diaphragm), all on the same side.

Stage II (Butchart System)
In stage II, cancer (mesothelioma) cells invade the chest wall involving the esophagus, heart, or pleura on both the sides. It could also involve the lymph nodes in the chest.

Stage III (Butchart System)
In stage III, the cancer (mesothelioma) has spread and penetrated through the diaphragm into the lining of the abdominal cavity (peritoneum). It could also involve the lymph nodes present beyond those in the chest.

Stage IV (Butchart System)
In stage IV, the cancer (mesothelioma) has spread into the bloodstream and to distant organs and tissues.

TNM Staging System
The TNM (T=Tumor, N=Nodes, M=Metastasis) system is based on the Butchart system, but is more detailed and precise with a few minor differences between both the systems.

In TNM, T stands for the tumor size and how far it has spread, N stands for the spread of cancer to the lymph nodes, and M stands for the spread of the cancer to distant organs (metastasis). As in the Butchart staging system, the severity of the cancer is divided into four stages in the TNM system; I through IV.

Stage I (TNM System)
In stage I, cancer (mesothelioma) cells are present in the right or left pleura and at times also in the lung, pericardium, or the muscle separating the chest from the abdomen (diaphragm), all on the same side.

Stage II (TNM System)
In stage II, cancer (mesothelioma) has spread from the pleura on one side to the lymph nodes on the same side next to the lungs and also possibly into the lung, pericardium or the diaphragm on the same side.

Stage III (TNM System)
In stage III, cancer (mesothelioma) has spread into the chest wall muscle, esophagus, heart, ribs, and other organs in the chest on the same side as the primary tumor.

Stage IV (TNM System)
In stage IV, cancer (mesothelioma) has spread to the lymph nodes in the chest on the opposite side of the primary tumor, and could also include the pleura or lung on the opposite side, the peritoneum, organs in the abdominal cavity or neck. The cancer could have spread into the bloodstream taking the cancer to distant organs beyond the chest and abdominal cavity.

Brigham Staging System
The Brigham system is the most recent staging system for mesothelioma. It takes into consideration variables such as lymph node status and tumor resectability (the ability to surgically remove a tumor).

The Brigham system too consists of four stages; I through IV.

Stage I (Brigham System)
In stage I, the cancer (mesothelioma) has not yet affected the lymph nodes and the mesothelioma is still resectable.

Stage II (Brigham System)
In stage II, the cancer (mesothelioma) has affected the lymph nodes, but the mesothelioma is still resectable.

Stage III (Brigham System)
In stage III, the cancer (mesothelioma) has penetrated the chest wall, diaphragm, heart, and abdominal cavity, with the lymph nodes either affected or unaffected. Mesothelioma is not resectable at this stage.

Stage IV (Brigham System)
In stage IV, the cancer (mesothelioma) has spread into the bloodstream and distant organs and tissues. Mesothelioma is not resectable at this stage.

Importance of Mesothelioma Staging
Staging plays a very important role in mesothelioma treatment because the physician / surgeon will base all further medications / treatment on the mesothelioma staging reports.

To stage the extent of the cancer, the surgeon will require to get several x-rays / CT scan / MRI scan / PET scan / combination of these scans.

It takes approximately 30 to 40 years for the symptoms of mesothelioma to surface. By this time the cancer is almost always in an advanced stage with no positive treatment possible and a survival rate of just 12 to 18 months after diagnosis. Surgeons today are testing new methods / medications to treat mesothelioma with promising results. It is expected that the survival rate after diagnosis will be up 5 to 10 years from the current 12 to 18 months. The survival time after diagnosis will just keep getting better and better.

If you know that you have been exposured to asbestos in the past 40 years, but still feel fit and fine, what you can do today is to get a thorough checkup done from a physician / surgeon reputed in handling mesothelioma cases. As described in the article, you could be diagnosed with stage I mesothelioma, making cure and long life a possibility.

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