4 Mesothelioma Stages | Staging Symptoms Treatment

Mesothelioma progresses through four stages. Early mesothelioma stages give a more hopeful prognosis, while a later diagnosis often means that the patient is limited to palliative care.

Key Point

  1. There are four stages of mesothelioma that are defined by certain disease characteristics.
  2. Early-stage patients have more treatment options and a better prognosis.
  3. Advanced, late-stage mesothelioma can often only be treated palliatively.
  4. The only kind of mesothelioma with an approved staging system is pleural mesothelioma.

There are four mesothelioma stages, indicating how far along the disease is in the body. The diagnosis process includes mesothelioma staging, which is important for creating a patient’s treatment strategy.

Most mesothelioma patients do not receive a diagnosis until stage 3 or 4 because of the lengthy latency period and general symptoms. Generally, in more advanced stages, patients have fewer curative treatment options and a poorer life expectancy. At stage 4, patients are likely to have only palliative treatment options available to relieve symptoms and improve their quality of life.

Mesothelioma Stages

Stage 1

  • Localized
  • No metastases or lymph node involvement.
  • Curative treatment options
  • Best forecast

Stage 2

  • Localized
  • The tumor has metastasized with minimal spread to lymph nodes.
  • Curative treatment is an option.

Stage 3

  • Located on one side of the body
  • The tumor has spread to nearby organs and lymph nodes.
  • Treatment options are usually comforting and non-surgical.

Stage 4

  • Spread on both sides of the body
  • The tumor has spread to several organs, lymph nodes, and blood vessels
  • Treatment is generally palliative

Pleural Mesothelioma Staging System

The only type of mesothelioma with an approved staging system is malignant pleural, the most prevalent type. Over the past few decades, numerous pleural mesothelioma staging systems have been created and used. Each staging system has specific criteria for the different stages. In all staging systems, however, it is clear that as the stage increases in number, the disease is generally more advanced, more difficult to treat, and has a poorer life expectancy.

TNM Staging System

The American Joint Committee on Cancer (AJCC) TNM staging approach is the most popular method of pleural mesothelioma staging. The Interim Storage System of the International Mesothelioma Interest Group (IMIG) is another name. The temporary storage system has received universal approval from the AJCC and IMIG and is regularly updated.

The terms tumor, node, and metastasis are abbreviated as TNM. After each letter in the TNM acronym, a number is assigned to denote the extent of disease in that specific category.

The information identified by TNM is then used collectively to assign a corresponding step. An individual with T1N0M0 illness, for instance, has a tumor that is contained to the site of origin and has neither nodal (N0) nor metastasized (M0) growth (M0). The TNM data in this illustration show a stage 1 diagnosis.

IASLC mesothelioma stage – TNM System

Stage I (IA and IB)

Refers to a sickness that only affects the primary or origin place. There are no metastases or illnesses in the lymph nodes. Surgery is frequently used to remove or resect stage I mesothelioma as treatment.

This stage can be divided into IA and IB depth of pleural tumor involvement.

Step II

Refers to disease with limited spread into the lung or diaphragm but not beyond, and also into the chest lymph nodes on the same side (ipsilateral).

Stage III (IIIA and IIIB)

Stage IIIA refers to disease with greater spread into the fascia lining the chest, fat, soft tissues of the chest wall or parts of the pericardium, and ipsilateral lymph nodes. Stage IIIB refers to a disease that has spread to lymph nodes of the breast on the opposite side (contralateral).

Step IV

Refers to disease where one of the following occurs: the tumor is too extensive for surgery, or there are distant metastases. Patients with tumors involving multiple or extensive portions of the chest wall, ribs, abdominal cavity, heart, trachea, esophagus, opposite thorax, spine, brachial plexus, or through the pericardium are classified as stage IV disease. Patients with tumors that have spread to distant sites in the body are also classified as having stage IV disease.

Brigham Staging System

The Brigham staging system is another older staging system for pleural mesothelioma. It primarily focuses on whether a tumor can be surgically removed (stages 1 and 2). The System also notes whether cancer has spread to the lymph nodes, which generally indicates a later stage unlikely to be amenable to surgery. Patients who undergo surgical resection have a better prognosis than patients who do not undergo surgical resection.

Stage I (IA and IB)

At this point, the mesothelioma is resectable, and there is no lymph node involvement.

Step II

Mesothelioma is still respectable in stage II, but the lymph nodes are now involved.

Stage III (IIIA and IIIB)

This stage involves the presence that extends into the chest wall, heart, or through the diaphragm, with or without lymph node involvement.

Step IV

This stage indicates distant metastatic disease (spread cancer throughout the body).

Butchart Staging System

The first staging system was the Butchart system. It largely depends on how big the initial tumor is. This approach has limitations because it was created by researchers using a tiny sample of actual patients. Additionally, it was created before the advent of contemporary imaging techniques like computed tomography.

Stage I (IA and IB)

Mesothelioma is found in the right or left pleura (the thin, transparent membrane that covers the lungs and lines the inside of the chest walls) and can also involve the diaphragm (the muscle that separates the chest from the abdomen) on the same side.

Step II

The esophagus, which connects the throat to the stomach and is a food conduit, heart, and the pleura have all been affected by mesothelioma, which invades the chest wall. Cancer that has progressed to stage II may also affect the lymph nodes in the chest.

Stage III (IIIA and IIIB)

Through the diaphragm, mesothelioma has entered the peritoneum, the lining of the abdominal cavity. Along with the lymph nodes in the breast, other lymph nodes may also be impacted.

Step IV

There are signs of metastasis (spreading mesothelioma) through the bloodstream to other organs.

Staging peritoneal, pericardial and testicular mesothelioma

There is currently no widely used staging method for peritoneal and testicular, in contrast to pleural mesothelioma. For a formal staging system to be developed and validated, there aren’t enough examples each year, which is why this is the case. Creating and validating staging systems and treatment alternatives becomes more challenging without a sizable patient sample.

Peritoneal Mesothelioma

Peritoneal mesothelioma is typically identified by more typical stage characteristics, as seen above, in the lack of a defined staging system. The Peritoneal Cancer Index (PCI), which assigns a grade to tumor size and location based on specific abdominal regions, is sometimes used by doctors. The PCI score taken can assist in assessing how far along mesothelioma is and whether a patient qualifies for surgery.

Suppose mesothelioma tumors are confined to the abdomen. In that case, surgical removal is often attempted with the option of delivering heated chemotherapy directly into the abdomen during surgery in a procedure called HIPEC (chemotherapy). If the disease is not limited to the abdomen, chemotherapy or radiotherapy to specific metastases may be given. The prognosis for peritoneal mesothelioma is generally poor. More than 50% of patients who can undergo HIPEC and surgical removal have a better prognosis and survive for five years or longer.

Pericardial mesothelioma

Because it is more uncommon, there is little data on its staging and very little available treatment. More general cancer stage characteristics usually determine pericardial mesothelioma stages. The size of the tumor on the pericardium, or the bag surrounding the heart, often determines what treatment is available.

Surgery involving the pericardium carries significant risk. Smaller tumors may be suitable for surgical removal, while larger tumors often cannot be removed safely. With so few cases, researchers are unclear about the best treatment options outside the surgery. The prognosis is generally poor, with many patients surviving between six and ten months from diagnosis.

Testicular Mesothelioma

Testicular mesotheliomais the rarest form of mesothelioma, accounting for only about 1% of all cases. Because of its rarity, doctors usually determine the staging mesothelioma cells are localized to one location in the testicles and spread beyond the area of ?? the primary disease site. Surgical removal of tumors that are confined to the abdomen or are confined to nearby lymph nodes offers the best chance of survival. The prognosis for testicular mesothelioma is about two years.

Develop A Treatment Plan After Staging

Along with the type, cell type, and general health of the patient, the stage of the patient’s mesothelioma is among the most crucial elements in formulating a treatment strategy. Patients diagnosed earlier may be advised to undergo surgery followed by chemotherapy and radiation therapy to improve the prognosis. In later stages, chemotherapy alone or together with radiotherapy is the standard care and can be applied palliatively.

New treatments, including therapy, have shown promise even for patients with more advanced diseases. In recent years, more mesothelioma clinical trials have reported effectiveness in prolonging life expectancy with novel treatment combinations and additional alterations to accepted treatment modalities. Even with such a dire prognosis, there is still hope, and some mesothelioma patients have lived months or years longer than their best-case scenario predicted.

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