Doctors often determine treatment options depending on the stage of mesothelioma. Doctors currently use one of three staging systems. Each system measures somewhat different variables.
Doctors most often use the Butchart System, the oldest staging system and the one that mainly considers the extent of primary tumor mass and divides mesothelioma into four stages. The more recent TNM system considers tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System, the latest system, stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.
Stage I of the Butchart System consists of the presence of mesothelioma in the lining of the right or left lung and may also involve the diaphragm on the same side. Stage II includes the invasion of mesothelioma into the chest wall or esophagus, hear, or lung lining on bother sides. In addition, lymph nodes in the chest may also be involved. The onset of Stage III begins when the mesothelioma penetrates through the diaphragm into the lining of the abdominal cavity or peritoneum. In this stage the cancer may also affect lymph nodes beyond those in the chest. Doctors identify Stage IV, the final stage, when evidence of metastasis or the spread of cancer to other organs exists.
Stage I of the TNM System involves the lining of the right or left lung, pericardium, or diaphragm on the same side. At this stage, lymph nodes are not involved. Stage II begins when mesothelioma spreads from the lining of the lung on one side to a lymph node on the same side. At this stage, the cancer may also spread to the lung, pericardium, or diaphragm on the same side. Stage III begins when mesothelioma exists in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor. In the final stage, Stage IV, the mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends into the lung opposite the primary tumor, or directly into the organs in the abdominal cavity or neck. Metastasis is included in this stage.
The Brigham System concerns itself primarily with the resectability (or ability to surgically remove) the mesothelioma mass. In Stage I the tumor is resectable and lymph nodes are unaffected. In Stage II the tumor remains respectable but the mesothelioma affects the lymph nodes. In Stage III the tumor becomes unresectable and extends into the chest wall, heart, or through the diaphragm, peritoneum. Stage III can occur with or without lymph node involvement. Stage IV occurs when doctors discover metastasic disease of distant organs.
Once doctors identify the stage of a patient's malignant mesothelioma, the patient and doctor can discuss and consider the various treatment options available.
The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, the location of the cancer, the spread of the cancer, the characteristics of the cancer cells under a microscope and the patient's age and desires.