The term used to explain the degree of a patient's cancer is called staging. This is based on the development of the primary tumor, its invasion of tissues and organs around it and the extent of its spread in the body. Currently, three staging systems are used for pleural mesothelioma, while there is no staging system yet used for peritoneal mesothelioma.
Over time, staging systems have changed and as scientists understand more about the disease, they continue to evolve. Some systems of staging center on specific cancers while some focus on various types of cancer. The most general staging systems for mesothelioma is the TNM (Tumor-Nodes-Metastasis). Generally it looks into the following:
• Area where the primary tumor is located
• Number and size of tumors
• Involvement of lymph node
• Tumor grade and cell type
• Metastasis or the extent of the spread of tumor
Cancer registries like the Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute use summary staging for all kinds of cancers. Summary staging have five main groups:
• In situ – cancer is found only in the layer of cells where it actually began
• Localized – cancer has no evidence of spread, it is limited only to the organ where it originally started
• Regional – cancer has spread from its primary location to lymph nodes and organs close by
• Unknown – cancer cases whose stage cannot yet be identified due to insufficient information
Doctors may need several methods of testing in order to identify the cancer stage of a patient. Once the patient's stage of mesothelioma is determined, the medical team can plan the appropriate treatment, make a prognosis and identify the clinical options that the patient may undergo.
• Physical Examinations – The physician thoroughly examines the patient by looking, touching or listening for anything unusual in the body.
• Laboratory Tests – These are procedures like blood, fluid, urine and tissue tests which are able to provide more data about the cancer.
• Imaging techniques – This includes processes such as CT scans, X-rays, PET scans or MRIs which may reveal the site and size of the tumor and whether or not it has spread.
• Surgical Reports – These are findings about the appearance and size of the tumor/s, lymph node/s and organs nearby.
• Pathology Findings – These are results of tissue sample examinations which may be able to give information concerning the size of the tumor/s, the extent it has spread, the cell types and grade of the tumor/s. It may also include results of cell examinations from a pleural effusion of mesothelioma.
Whatever information and details are gathered as a result of the staging should be communicated by the doctors to the cancer patient so that they can discuss possible treatment plans. Aside from the stage of mesothelioma, other factors need to be considered, such as the patient's age, status of his health and his personal wishes regarding the treatment.
Butchart System is among the often used staging systems. It is also the oldest and is mainly based on the extent of the primary tumor mass.
Here is how the Butchart System measures the staging:
• Stage I – Mesothelioma is found in the left or right pleura and can also involve the diaphragm on the side where it is present.
• Stage II – Mesothelioma attacks the chest wall or invades the esophagus, the heart or both pleura. There may also be lymph nodes found in the chest.
• Stage III – Mesothelioma penetrates through the diaphragm and into the peritoneum or abdominal cavity lining. Lymph nodes may also be found beyond the chest area.
• Stage IV – Mesothelioma has spread to other organs through the bloodstreams; meaning, an evidence of metastasis is discovered.
Another system of staging is the TNM System – (Tumor-Nodes-Metastasis). It is a more recent system whose variables include the mass and spread of tumor, involvement of lymph nodes and metastasis.
• First Stage – Mesothelioma is in the left or right pleura; may have scattered to the lung, pericardium or the diaphragm on the side where it is located
• Second Stage – Mesothelioma has scattered from one side of the pleura to lymph nodes that are close by and to the same lung side. It probably also reached the lung, pericardium or the same diaphragm side
• Third Stage – Mesothelioma is already in the wall of the chest, ribs, muscle, esophagus, heart or chest organs on same side, whether or not it has spread on the area same as the lymph nodes and the primary tumor
• Fourth Stage – Mesothelioma has scattered to the lymph nodes on the chest opposite the primary tumor; or it may extend to the pleura on the other side; or it could extend directly to the organs in the neck or abdominal cavity. All distant metastases are involved in this stage.
Brigham System is another type; the latest actually. Its variables include nodal status and tumor resectablility (the ability to be removed by surgery).
• Stage 1 – Resectable mesothelioma; no lymph node involved
• Stage 2 - Resectable mesothelioma; with lymph node involved
• Stage 3 - Unresectable mesothelioma extends to the wall of the chest, heart and through the diaphragm and peritoneum; they may or may not be extra-thoracic lymph node involved
• Stage 4 – The disease involves distant metastasis
Over time, staging systems have changed and as scientists understand more about the disease, they continue to evolve. Some systems of staging center on specific cancers while some focus on various types of cancer. The most general staging systems for mesothelioma is the TNM (Tumor-Nodes-Metastasis). Generally it looks into the following:
• Area where the primary tumor is located
• Number and size of tumors
• Involvement of lymph node
• Tumor grade and cell type
• Metastasis or the extent of the spread of tumor
Cancer registries like the Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute use summary staging for all kinds of cancers. Summary staging have five main groups:
• In situ – cancer is found only in the layer of cells where it actually began
• Localized – cancer has no evidence of spread, it is limited only to the organ where it originally started
• Regional – cancer has spread from its primary location to lymph nodes and organs close by
• Unknown – cancer cases whose stage cannot yet be identified due to insufficient information
Doctors may need several methods of testing in order to identify the cancer stage of a patient. Once the patient's stage of mesothelioma is determined, the medical team can plan the appropriate treatment, make a prognosis and identify the clinical options that the patient may undergo.
• Physical Examinations – The physician thoroughly examines the patient by looking, touching or listening for anything unusual in the body.
• Laboratory Tests – These are procedures like blood, fluid, urine and tissue tests which are able to provide more data about the cancer.
• Imaging techniques – This includes processes such as CT scans, X-rays, PET scans or MRIs which may reveal the site and size of the tumor and whether or not it has spread.
• Surgical Reports – These are findings about the appearance and size of the tumor/s, lymph node/s and organs nearby.
• Pathology Findings – These are results of tissue sample examinations which may be able to give information concerning the size of the tumor/s, the extent it has spread, the cell types and grade of the tumor/s. It may also include results of cell examinations from a pleural effusion of mesothelioma.
Whatever information and details are gathered as a result of the staging should be communicated by the doctors to the cancer patient so that they can discuss possible treatment plans. Aside from the stage of mesothelioma, other factors need to be considered, such as the patient's age, status of his health and his personal wishes regarding the treatment.
Butchart System is among the often used staging systems. It is also the oldest and is mainly based on the extent of the primary tumor mass.
Here is how the Butchart System measures the staging:
• Stage I – Mesothelioma is found in the left or right pleura and can also involve the diaphragm on the side where it is present.
• Stage II – Mesothelioma attacks the chest wall or invades the esophagus, the heart or both pleura. There may also be lymph nodes found in the chest.
• Stage III – Mesothelioma penetrates through the diaphragm and into the peritoneum or abdominal cavity lining. Lymph nodes may also be found beyond the chest area.
• Stage IV – Mesothelioma has spread to other organs through the bloodstreams; meaning, an evidence of metastasis is discovered.
Another system of staging is the TNM System – (Tumor-Nodes-Metastasis). It is a more recent system whose variables include the mass and spread of tumor, involvement of lymph nodes and metastasis.
• First Stage – Mesothelioma is in the left or right pleura; may have scattered to the lung, pericardium or the diaphragm on the side where it is located
• Second Stage – Mesothelioma has scattered from one side of the pleura to lymph nodes that are close by and to the same lung side. It probably also reached the lung, pericardium or the same diaphragm side
• Third Stage – Mesothelioma is already in the wall of the chest, ribs, muscle, esophagus, heart or chest organs on same side, whether or not it has spread on the area same as the lymph nodes and the primary tumor
• Fourth Stage – Mesothelioma has scattered to the lymph nodes on the chest opposite the primary tumor; or it may extend to the pleura on the other side; or it could extend directly to the organs in the neck or abdominal cavity. All distant metastases are involved in this stage.
Brigham System is another type; the latest actually. Its variables include nodal status and tumor resectablility (the ability to be removed by surgery).
• Stage 1 – Resectable mesothelioma; no lymph node involved
• Stage 2 - Resectable mesothelioma; with lymph node involved
• Stage 3 - Unresectable mesothelioma extends to the wall of the chest, heart and through the diaphragm and peritoneum; they may or may not be extra-thoracic lymph node involved
• Stage 4 – The disease involves distant metastasis
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