Mesothelioma Stages

There are four stages of mesothelioma that describe how far the cancer has spread. Patients diagnosed with mesothelioma also receive a stage. The stage informs treatment and helps doctors estimate a prognosis and life expectancy.

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What Are the Four Stages of Mesothelioma?

All types of cancer have four stages. A stage describes the location of the tumors in the body. The four stages of mesothelioma include:

• Stage 1 – The tumors are in the mesothelium of one lung.
• Stage 2 – The tumors have spread beyond the mesothelium to other organs, such as nearby lymph nodes.
• Stage 3 – The tumors have spread deeper into nearby tissues and more distant lymph nodes.
• Stage 4 – The tumors have spread to distant parts of the body. This is called metastasis.

About Cancer Staging

Mesothelioma and other cancers are staged to describe the extent of the cancer. TNM is the most commonly used staging system for all cancers. There are also alternative staging systems used for mesothelioma:

• Brigham Staging System
• Butchart Staging System

Also important in mesothelioma is the classification of resectable or non-resectable. This broad classification refers to cancer that can be treated with surgery and cancer that has spread too far for surgery.

Why Do Doctors Stage Mesothelioma?

Staging is a standard part of mesothelioma diagnosis. It provides important and detailed information about where the cancer is in the body. Reassessing the stage over time helps doctors determine how fast the cancer is spreading and how effective treatments are.

The cancer stage also helps the medical team estimate a patient’s prognosis. The stage is one important determining factor in life expectancy.

TNM Staging for Mesothelioma

Doctors created a staging system known as the TNM Classification of Malignant Tumors in the 1990s. TNM stands for Tumor Node Metastasis.

Although there are other accepted staging systems, the TNM staging system is the most widely accepted and used by mesothelioma doctors. It helps classify the following stages:

Stage 1: Localized Mesothelioma

Stage 1 is the first stage of mesothelioma. It’s broken up into either stage IA or stage IB. At this point, the cancer is still localized, and patients have the best chances of successful treatment.

Stage 1A is diagnosed when the cancer is located in either the lining of one side of the chest wall or the chest cavity lining between the lungs. Cancer has not yet spread at this stage from these points in the body.

Stage 1B is diagnosed when the cancer is found in both the lining of the chest walls and the lining of the chest cavity. Again, cancer has not yet spread from these points.

Stage 2: The First Advanced Stage

When patients are in stage 2, the cancer is no longer localized, and they are now in the first phase of the advanced stage of the disease.

During this stage, the cancer is not only in the lining of the chest wall and chest cavity but also in the lining that protects the lungs and the diaphragm.

However, keep in mind that cancer can be in the lining of either the lungs, the lining of the diaphragm, or both.

Stage 3: Advanced Mesothelioma

During stage 3, cancer is found in the lining of one side of the chest wall and may have also spread to the chest cavity lining, the diaphragm lining, and the lung lining. Cancer has now spread to the lymph nodes close to the victim’s esophagus and trachea.

Stage 4: Metastatic Mesothelioma

Stage 4 is the most advanced stage of the disease, and cancer can no longer be removed surgically. During this stage, the cancer has metastasized. This means it has spread to more distant parts of the body.

Examples of locations of metastasis include the stomach, liver, kidneys, bones, heart, and brain. Stage 4 mesothelioma is always terminal.

How Quickly Does Mesothelioma Progress?

From the time of asbestos exposure to the symptoms that lead to a diagnosis, mesothelioma takes a long time to progress. This period of time is called the latency period, and it is decades on average.

Once a patient is diagnosed with mesothelioma, the cancer usually progresses rapidly through the stages. Mesothelioma is aggressive and tends to spread quickly. There are individual factors to consider, such as treatment choices, but compared to other types of cancer, mesothelioma spreads aggressively and rapidly.

What Are the Symptoms of Pleural Mesothelioma By Stage?

Every patient is different, but there are common symptoms that occur in each stage of mesothelioma.

Symptoms of stage 1 mesothelioma:

• Mild chest pains
• Coughing
• Shortness of breath

Symptoms of stage 2 mesothelioma:

• Mild chest pains
• Coughing
• Shortness of breath
• Unexplained weight loss

Symptoms of stage 3 mesothelioma:

• Chest pains
• Chest tightness
• Lumps under the skin of the chest
• Wheezing and difficulty breathing
• Coughing, sometimes with blood
• Fever
• Fatigue
• Unexplained weight loss

Symptoms of stage 4 mesothelioma:

• Chest pains
• Extreme shortness of breath and difficulty breathing
• Coughing with blood
• Fever
• Fatigue
• Night sweats
• Weight loss
• Muscle wasting
• General malaise

Staging Peritoneal Mesothelioma

Pleural mesothelioma accounts for nearly 80% of mesothelioma diagnoses. Staging is also important for peritoneal mesothelioma, a less common form of mesothelioma. It first develops in the peritoneum, the tissue lining the abdominal cavity, and spreads from there.

There is no standardized staging system for peritoneal mesothelioma. Some doctors use the Peritoneal Cancer Index (PCI), but it is imperfect. The PCI was developed to stage metastases of gastric cancer.

Some doctors adapt the TNM system to describe the different stages of peritoneal mesothelioma. Many believe this is a better way to predict prognosis for patients. A group of researchers suggested a new staging system for peritoneal mesothelioma based on:

• The extent of tumors using the PCI
• Tumor spread within the abdomen
• Metastasis, or the spread of tumors outside the abdomen

Resectable and Unresectable Mesothelioma

TNM stages the development of mesothelioma so that doctors will have a better understanding of the victim’s prognosis. However, when determining which treatments are best according to each stage, doctors often refer to the cancer as either resectable or unresectable.

If the tumors are resectable, they can be surgically removed. Likewise, if the tumors cannot be removed, they are considered unresectable.

In most cases, the first three stages of mesothelioma are considered resectable. However, there are always a few exceptions. The subtype of the cancer, along with how far it has grown into the body’s tissues, will determine if it can be removed.

Doctors also take into account the patient’s health. Unhealthy people generally are not candidates for surgery and removal.

Alternative Mesothelioma Staging Systems

TNM staging is the most widely used staging system by most physicians, other systems have also helped diagnose stages of mesothelioma, including:

The Brigham System

Created by Dr. David Sugarbaker, one of the leading mesothelioma physicians at the Brigham and Women’s Hospital at Harvard, the Brigham System uses both clinical and radiological advances to find the development of the disease and the diagnosis.

Similar to TNM staging, the Brigham System utilizes four stages to determine cancer development:

• Stage I: Lymph nodes are not involved during this stage, and the cancer is only in the pleural area.
• Stage II: The cancer is still locked in the pleural area but may have also spread to the lymph nodes.
• Stage III: The cancer has now transferred into the diaphragm, structures in the thorax, or the diaphragm.
• Stage IV: The cancer has spread to various parts of the body and is now considered unresectable.

The Butchart Staging System

The Butchart staging system is the original staging system used to stage pleural mesothelioma. As with other systems, the Butchart staging system classifies mesothelioma into four stages, with the final stage being the most severe.

This particular staging system was created in 1979 by Dr. Eric Butchart, a cardiothoracic surgeon at the University Hospital in Wales, United Kingdom.

Dr. Butchart created the staging system to determine which mesothelioma patients were ideal candidates for different types of treatments.

• Stage I: The cancer is on one side of the lining of the lungs or one side of the lining of the heart.
• Stage II: Tumors are now on both sides of the lining of the lungs in addition to either the chest wall, heart, or esophagus. Mesothelioma cells have also reached the lymph nodes. Radiation therapy is advised during this stage as long as the patient is healthy enough.
• Stage III: Tumors have invaded either the lining of the stomach or the diaphragm. In addition, the mesothelioma cells have now made their way outside of the chest and into the lymph nodes. Dr. Butchart suggests cytotoxic drugs in combination with drainage via tubes during this stage.
• Stage IV: Tumors have now transferred across the body and into the patient’s bloodstream. They can be found in several body organs, including the liver, brain, and even the bones. At this point, Dr. Butchart advises palliative mesothelioma treatment only as the tumors are too advanced to be removed.

How Does Mesothelioma Staging Affect Treatment and Prognosis?

The two main reasons staging is so important is that it provides valuable information for planning treatment and estimating prognosis.

Mesothelioma Treatment By Stage

There is no single treatment plan for each stage of mesothelioma because doctors must consider multiple, individual factors for each patient. Stage is one of the most important factors, though, and plays a significant role in determining a general treatment plan:

• Stage 1 Mesothelioma Treatment. Surgery is usually recommended during stage 1, while the tumors are still highly localized. Surgery at this time is much more likely to be successful than at later stages. It is typically used along with chemotherapy, radiation therapy, or both.
• Stage 2 Mesothelioma Treatment. Patients in stage 2 might still be eligible for surgery, but it depends on individual factors and the exact locations of tumors. Stage 2 treatment usually also includes chemotherapy, radiation therapy, and immunotherapy.
• Stage 3 Mesothelioma Treatment. Treatment goals at stage 3 typically include extending a patient’s life and making them more comfortable. Surgery is not usually an option unless it is for palliative care. Patients benefit from chemotherapy, radiation therapy, and immunotherapy.
• Stage 4 Mesothelioma Treatment. Stage 4 treatment is mostly palliative and includes minor palliative procedures, chemotherapy, and immunotherapy.

Mesothelioma Prognosis By Stage

Prognosis and survival time are also highly individualized. They depend on individual patient factors and characteristics, like age, health, and treatment preferences. Looking at large numbers of patients, researchers have generalized life expectancy for mesothelioma patients by stage:

• Stage 1 – 22.2 months
• Stage 2 – 20.0 months
• Stage 3 – 17.9 months
• Stage 4 – 14.9 months

Staging is an integral part of the diagnostic process for mesothelioma. Talk to your medical team about your stage and what it means for your treatment options and prognosis.

Getting Legal Assistance

Regardless of which stage of mesothelioma you are in, you may be entitled to financial compensation. Don’t forget to fill out our form to get our free Financial Compensation Packet, filled with information on the experienced asbestos and mesothelioma attorneys in your area. For additional assistance, contact us at 800-793-4540.