Mesothelioma Stages

Malignant mesothelioma is classified according to the disease stage, or severity. A stage is a way to determine how much the disease has spread and how much it will respond to treatment.

In general, there are four stages to any type of cancer, including mesothelioma. This ranges from stage I, meaning the disease is confined in a limited area and treatable, to stage IV, which means the disease has spread to other organs, bones and blood. A stage is determined when a patient is diagnosed. It is useful in determining the next step in treatment.

In addition to the individual stages of asbestos-related cancer, there are a variety of staging systems, or methods, used to diagnose malignant asbestos cancerous diseases:

Butchart Staging System

Created in 1976 for staging pleural mesothelioma, this assigns a stage to the cancer based on location, size and extent of the pleural tumors. This is primarily used to help physicians decide which patients are candidates for advanced treatments. Patients who are in the early stages of the Butchart system are generally in better health and have a better overall prognosis. The Butchart system is the most widely used system for asbestos-cancer patients.

Butchart Stages

• Stage I - The asbestos cancer is confined to only one side of the body -- either the right or left side pleura. It may also include the pericardium, lung and diaphragm on the same side. Curative treatments are considered at this stage.
• Stage II - The disease has infiltrated the chest wall, both sides of the pleura and possibly the esophagus and heart. A limited area of lymph nodes may be involved. The Butchart system recommends that patients in this stage receive high-dose radiation among the possible treatments.
• Stage III - The tumors have grown through the peritoneum (the lining that surrounds the abdominal area). Cancer cells have spread to outer-lying lymph nodes. The Butchart system recommends that these patients receive only palliative measures.
• Stage IV - Tumors have spread and grown throughout the body, including the brain, bones and liver. This is considered terminal cancer.

TNM Staging System

Created in 1995 by the International Mesothelioma Interest Group (IMIG), this is aimed at producing a uniform staging system for all asbestos-cancer patients. This defines the cancer based on three distinct areas -- size and location of the tumor (T), whether lymph nodes are involved (N) and the metastasis of the disease (M).

Like Butchart, this staging system grades the disease from numbers 1 to 4. In fact, there are only minor differences between the Butchart and TNM staging systems.

Brigham Staging System

Created by famed mesothelioma physician Dr. David Sugarbaker of the Brigham and Women’s Hospital, this staging system is aimed at describing which patients are viable candidates for curative surgery.

• Stage 1 - The cancerous cells are localized in the lining that surrounds the lungs and the chest walls. Surgery is an option.
• Stage 2 - The cancer is still localized but has moved to the lymph nodes also. Surgery is an option.
• Stage 3 - The disease has spread to areas that include the chest wall and abdominal area. Surgery is not an option.
• Stage 4 - The disease has moved into the bloodstream, bones and distant areas in the body. Surgery is not an option.

Each staging system is aimed at helping physicians mount a better fight against asbestos cancer. But a staging system is only as good as the physician using it. Only a skilled mesothelioma specialist is knowledgeable about the best ways to treat the disease.