When someone receives a cancer diagnosis, they will usually only receive their diagnosis following a number of tests and scans. The results of these tests also help doctors determine how advanced the cancer is. Determining the stage a cancer has reached is important as it helps the treating medical team decide what treatments are best for the patient. It also influences the patient’s prognosis and outlook for the future.
Importantly, the two main types of mesothelioma – pleural mesothelioma and peritoneal mesothelioma – have different staging.
Below we describe how both forms of mesothelioma are staged.
How is Pleural Mesothelioma staged?
The most common form of mesothelioma is pleural mesothelioma. This affects the lining of the lungs (pleura) and can cause various symptoms. These symptoms may include:
- Shortness of breath
- Chest and/or lower back pain
- Unexplained weight loss
- A persistent cough.
The most commonly used system for mesothelioma staging in the UK is the International Mesothelioma Interest Group. The system takes three main components into consideration when considering the stage of the cancer. These components are:
- Tumour – The size and position of the primary mesothelioma tumour.
- Node – Whether mesothelioma cells spread to nearby lymph nodes.
- Metastasis – Whether the cancer has metastasized i.e. whether mesothelioma cells have spread to other parts of the body.
This system is known as TNM (Tumour, Node, Metastasis). Once a patient review has taken place and the above information is collated, it is used to give the staging. We describe each stage in detail below:
Pleural mesothelioma stage 1
At this stage, the mesothelioma cells are in the pleura of the lung on one side of the body.
Pleural mesothelioma stage 1a
At this stage, the mesothelioma cells are on the parietal pleura (outer layer) of the lung on one side of the body.
Pleural mesothelioma stage 1b
At stage 1b the mesothelioma cells are on the visceral pleura (inner layer) of the lung on one side of the body. Importantly, the mesothelioma cells have not spread to lung tissue or the diaphragm.
Patients diagnosed at stage 1, 1a or 1b have the best prognosis when it comes to treatment options and life expectancy.
Pleural mesothelioma stage 2
At stage 2 the mesothelioma will have spread to both the parietal and visceral pleura on one side of the body. It will have formed a tumour mass on the pleural tissue. Alternatively, the mesothelioma may have spread to the lung tissue or diaphragm.
Pleural mesothelioma stage 3
At stage 3 the mesothelioma has spread to the chest wall or the pericardium (lining of the heart). Alternatively, it may have spread to the lymph nodes. At stage 3 surgery is still a potential option to remove the mesothelioma.
Pleural mesothelioma stage 4
Finally by stage 4 the mesothelioma has spread to various parts of the chest wall or grown through the diaphragm into the peritoneum. Alternatively, the mesothelioma may have spread to the pleura on the other side of the body, the chest organs, or the other layer of the pericardium.
The mesothelioma could have spread far beyond the lining of the lung to lymph nodes or above the collarbone. It may also have invaded other parts of the body.
Unfortunately, when mesothelioma reaches stage 4 surgery to remove it is no longer an option.
Peritoneal mesothelioma staging
Unlike pleural mesothelioma, there is no staging system for peritoneal mesothelioma. However, doctors are still likely to use the TNM system to advise patients on how advanced their cancer is and the treatment options available to them.
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