Mesothelioma Staging

Formulating a treatment plan for a mesothelioma patient depends on a number of different variables. Physicians will consider the location of the patient’s overall health and age, their preferences for how aggressively they want to be treated, and the exact type of mesothelioma that the patient has been diagnosed with. One of the most important things taken into consideration is exactly how far the disease has progressed within the body. This is determined by a process known as staging, which is done with every type of cancer.

Staging is done through a combination of physical exams, imaging tests such as CT scan and PET scan, and biopsies. By analyzing the results of each of these inquiries, doctors are able to tell how early the condition was caught and what treatment protocols are likely to be most effective, or are even possible.

In the case of malignant mesothelioma, most oncologists employ the TNM staging system, which looks at three different aspects of the disease. These are:

  1. The spread of the primary tumor (T)
  2. Whether the cancer has spread to nearby lymph nodes (N)
  3. Whether the cancer has metastasized to other organs (M)

In assessing each of these three factors, physicians then assign numbers that express the degree or severity of the cancer’s advance, and then classify the cancer into four different stages. These are:

Stage I: The cancer has grown into the pleural lining of the chest wall on one side of the chest, and may have also impacted the lining of the diaphragm or the space between the lungs, or even the lung. The mesothelioma has not spread to either the lymph nodes or metastasized to other parts of the body.

Stage II: The cancer has grown into all of the sites listed above, including the lining of the diaphragm , the space between the lungs and the lung. It has also grown into the diaphragm, or lung, or both, but has not spread to either the lymph nodes or metastasized to other parts of the body.

Stage III: This can be either of two scenarios:

  • All of the details listed above as well as spreading to lymph nodes on the same side as the tumor without spreading to distant sites.
  • All of the areas listed above as well as the first layer of the chest wall and/or the outer covering of the heart, and may or may not have spread to lymph nodes near the collarbone or on opposite sides of the chest, with no cancer having metastasized to distant sites.

Stage IV: This can be any of the following scenarios:

  • All of the above scenarios with the cancer having grown through the diaphragm and into the peritoneum, any organ in the cavity, into the spine, to the other side of the chest, and/or through the heart lining into the heart itself. It may or may not have spread to lymph nodes and has not spread to distant sites.
  • The tumor may or may not have grown into nearby tissues but has spread to lymph nodes near the collarbone on either side and/or to lymph nodes on the opposite side of the main tumor, and has not spread to distant sites.
  • The tumor may or may not have grown into nearby tissues or to any lymph nodes, but has spread to distant sites.

In addition to this staging system, which only applies to pleural mesothelioma, physicians may also generally divide malignant mesothelioma into categories of resectable versus unresectable, which refers to whether or not the tumor can be removed by surgery. In most cases, Stage IV mesothelioma is not resectable, and in most cases even when surgery is done, there are cancer cells left behind. This is why patients who undergo surgery are also treated with additional protocols, including radiation therapy, chemotherapy and immunotherapy.

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