If your doctor suspects you may have mesothelioma they will likely want you to have a biopsy where a sample of tissue or fluid is taken and then tested for the cancer. Once a diagnosis of mesothelioma has been confirmed, they will look to see what stage the cancer is at.
There are two main types of mesothelioma, pleural mesothelioma which affects the lining of the lungs and peritoneal mesothelioma which affects the lining of the abdomen.
The most common method for staging of pleural mesothelioma is based on the TNM (tumour, node, metastasis) system. This is also used for almost all cancers, apart from those in children, leukaemia or cancers of the central nervous system.
TNM system
The TNM system looks at three factors:
T – tumour; the size and location of the primary tumour
N – nodes; has it spread to the lymph nodes?
M – metastases; has the tumour spread to other parts of the body?
The system gives 4 stages of mesothelioma, 1 being the earliest stage and 4 being the most advanced.
Pleural mesothelioma stage 1
There are mesothelioma cells in the pleura of the lung on only one side of the chest
Pleural mesothelioma stage 1a
There are mesothelioma cells in the outer layer of the pleura of the lung on only one side of the chest.
Pleural mesothelioma stage 1b
There are mesothelioma cells in the inner layer of the pleura of the lung on only one side of the chest and these have not spread to the diaphragm or lung tissue.
Pleural mesothelioma stage 2
There is mesothelioma in both layers of the pleura of the lung on only one side of the body and they have spread to the diaphragm or the lung tissue.
Pleural mesothelioma stage 3
The mesothelioma has spread to the chest wall, lymph nodes or is covering the lining of the heart but can still potentially be removed through surgery.
Pleural mesothelioma stage 4
By stage 4, the mesothelioma cannot be removed through surgery as it has spread through the chest wall and may have spread to other parts of the body.
Staging for peritoneal mesothelioma
Currently, for peritoneal mesothelioma, there is no established staging system but doctors may use the TNM staging method as used for pleural mesothelioma.
Why is staging important?
The treatment you are offered will depend on the stage your mesothelioma is at. If you are at stage 4, you would not be offered surgery as the cancer cannot be removed by this stage.
Although there is currently no cure for mesothelioma, there are treatments which can prolong life, improve quality of life and reduce symptoms. The earlier the diagnosis, the more treatment options there are.
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