How Mesothelioma Is Staged

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Doctor and surgeon conferMesothelioma is a general term for cancer that affects the mesothelium tissue surrounding internal organs. All forms of mesothelioma area are serious and are most often caused by asbestos exposure. However, not all forms of mesothelioma are the same. Instead, mesothelioma is categorized by where in the body it occurs.

According to the Mayo Clinic, the different forms of mesothelioma include:

  • Pleural mesothelioma, which occurs in the mesothelium around the lungs.
  • Peritoneal mesothelioma, which occurs in the mesothelium in the abdomen.
  • Pericardial mesothelioma, which occurs in the mesothelium around the heart.
  • Mesothelioma of tunica vaginalis, which occurs in the mesothelium around the testicles.

Often, the severity of cancer is described in stages. Treatment and prognosis are often largely dependent on the stage at which the cancer is diagnosed. However, when it comes to mesothelioma the only type of mesothelioma that is staged is pleural mesothelioma.

The Many Stages of Pleural Mesothelioma, According to the American Cancer Society

Before pleural mesothelioma can be staged, three important pieces of information will need to be known. This type of staging is known as the American Joint Committee on Cancer TNM system. In order to stage pleural mesothelioma in this way, you will need to know about the:

  • Tumor. The size, location(s), and whether it is possible to surgically remove the cancer will be relevant to the staging process.
  • Lymph nodes. Whether the cancer has spread to the nearby lymph nodes is relevant to the staging process.
  • Metastasis. Whether the cancer has spread in the body is going to be relevant to the staging process.

Once you have this information, then you can stage pleural mesothelioma.

Stage IA

Pleural mesothelioma is considered to be at Stage IA if the cancer is the pleura lining of the chest wall on one side of the chest. It may, or may not, affect the pleura lining of the diaphragm, the mediastinum (the space between the lungs), or the pleura lining covering the lung. In some cases, it may have spread into the diaphragm or the lung. However, it has not spread to nearby lymph nodes or to distant sites.

Stage IB

At Stage IB, the cancer has spread but it may still be possible to surgically remove the cancer. The tumor is in the pleura lining of the chest wall on one side of the chest and in the pleura lining of the diaphragm, the mediastinum, and the pleura lining of the lung on the same side of the chest. Additionally, it has spread to at least one of the following places: the first layer of the chest wall, the fatty tissue in the mediastinum, a single place in the deeper layers of the chest wall, or the surface of the pericardium. It has not, however, spread to the nearby lymph nodes or to distant sites.

Stage II

By Stage II the cancer has spread. The mesothelioma is still in the pleura lining of the chest wall on one side of the chest and it may have grown into the diaphragm or lung. It has spread to the nearby lymph nodes, but it has not yet spread to distant sites in the body.

Stage IIIA

Stage IIIA mesothelioma has spread to nearby areas, but may still be treated with surgery in some cases. This stage of mesothelioma is in the pleura lining of the chest wall on one side of the chest and in the pleura lining of the lung, the diaphragm, and mediastinum on the same side. Additionally, it has spread to at least one of the following places: the first layer of the chest wall, the fatty tissue in the mediastinum, a single place in the deeper layers of the chest wall, or the surface of the pericardium. It has spread to lymph nodes.

Stage IIIB

By Stage IIIB, the mesothelioma has become too widespread for surgical removal. This stage of mesothelioma is in the pleura lining of the chest wall on one side of the chest and in the pleura lining of the lung, the diaphragm, and mediastinum on the same side. Additionally, it has spread to at least one of the following: multiple places in the deeper layers of the chest wall; through the diaphragm and into the peritoneum; to any organ in the mediastinum (such as the esophagus, trachea, thymus or blood vessels); to the spine; across the pleura to the other side of the chest; through the pericardium; or into the heart. The cancer may or may not be in the lymph nodes, but it has not spread to distant sites in the body.

Stage IV

Stage IV mesothelioma has spread to distant parts of the body. It may be in the bones, the liver, the lung or pleura on the other side of the body, or the peritoneum. It may or may not have spread to the lymph nodes or into nearby parts of the body.

Other Staging Considerations

It is also possible to be diagnosed with pleural mesothelioma and not have it staged in any of the ways described above. Instead, it may be described as TX (meaning the main tumor cannot be assessed because there is not enough information), TO (meaning that there is no evidence of a primary tumor), or NX (meaning that the nearby lymph nodes cannot be assessed because there is not enough information).

Additionally, your doctor may use a different description of your pleural mesothelioma and refer to your cancer as resectable (meaning that the cancer can be completing removed during surgery) or unresectable (meaning that the cancer cannot be completing removed during surgery).

Other Ways to Stage Pleural Mesothelioma

In addition to the TNM system described above, there are two other ways to stage pleural mesothelioma.

The Butchart System

This is the oldest system of staging mesothelioma and is based largely on the tumor mass. The four stages in the Butchart System of staging mesothelioma consist of:

  • Stage I. The mesothelioma is in the right or left side of the chest area or pleura cavity and may also be in the diaphragm.
  • Stage II. The mesothelioma has invaded the chest lining and reached the esophagus, heart or pleura on both sides. The lymph nodes may be affected.
  • Stage III. The mesothelioma has passed the diaphragm and entered the abdomen or peritoneum. Lymph nodes beyond the chest may also be affected.
  • Stage IV. The mesothelioma has spread through the bloodstream to other organs and has become metastatic mesothelioma.

The Brigham System

The Brigham System considers two factors in staging mesothelioma: whether it can be surgically treated and whether the lymph nodes are affected. The four stages in the Brigham System are:

  • Stage I. The mesothelioma can be treated surgically and the lymph nodes are not involved.
  • Stage II. The mesothelioma can be treated surgically but the lymph nodes are involved.
  • Stage III. The mesothelioma cannot be treated surgically and the cancer has spread to the chest wall, diaphragm, heart, or abdomen. The lymph nodes may or may not be involved.
  • Stage IV. The mesothelioma has metastasized to distant parts of the body.

Let Neblett, Beard & Arsenault Help You After a Mesothelioma Diagnosis

Regardless of how your mesothelioma is staged, you need the help of an experienced lawyer to make the fair legal recovery that you deserve. Mesothelioma is almost always caused by asbestos exposure and those responsible for your exposure may have a legal duty to compensate you for your illness. However, your exposure likely happened decades ago and you may need help gathering the right evidence and making compelling arguments to secure your recovery.

You deserve the help of an experienced legal team without the stress of worrying about how to pay for an attorney. Our lawyers would be pleased to meet with you for a free consultation and we will work on a contingency fee basis. That means that we are only paid a percentage of your legal recovery and that there are no upfront costs. To learn more, or to schedule your free consultation, please call us or reach out to us via this website today.
 

Richard J. Arsenault
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Recognized by several legal associations, Richard Arsenault has vast experience in complex litigation cases.