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Staging of pleural mesothelioma

From Staging of pleural mesothelioma

Mesothelioma main Diagnosis Chemotherapy  

Various staging systems have been used for mesothelioma during the past 3 decades since its recognition. The first staging system for mesothelioma was published by American Joint Commission on Cancer (AJCC) and was accepted International Union Against Cancer. This publication appeared in the fifth edition of AJCC Cancer Staging Manual. The current staging system used by AJCC is the staging system proposed by International Mesothelioma Interest Group (IMIG) in the year 1995. This staging system is based on the relationship between tumor size, nodal status, and overall survival. This staging system applies to only those tumors that arise from the pleura. Peritoneal and pericardial mesotheliomas are rare and are difficult to classify in terms of tumor size and nodal and metastatic status.

Primary site (T)
The mesothelium from which the mesothelioma originates covers the external surface of the lungs and inside of the chest wall. Mesothelium consists of flat, tightly connected cells, which are one layer thick.

Regional lymph nodes (N)
The lymph nodes located in the internal mammary chain, intra-thoracic area, scalene lymph nodes, and supraclavicular lymph nodes may be involved with mesothelioma. These designations are identical to the designations used for lung cancer.

Distant metastasis (M)
Distant metastasis of pleural mesotheliomas may occur to retroperitoneal lymph nodes, brain, and spine. Most common site of metastatic spread is peritoneum, pleural surface on the other side and lung.

IMIG staging system for malignant pleural mesothelioma
Primary tumor (T)
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Tumor involves same side pleura of the chest wall, with or without focal involvement of the pleura on the outer side of lung
T1a: Tumor involves same side pleura of the chest wall, no involvement of pleura on the outer surface of lung
T1b: Tumor involves same side pleura of the chest wall with focal involvement of pleura on the outer surface of lung
T2: Tumor involves same side pleura of the chest wall with at least one of the following features:
  • Confluent tumor on the outer surface of the lung
  • Involvement of the muscles of the diaphragm
  • Involvement of the lung tissue deeper to the mesothum covering the lung

  • T3: Tumor involves same side pleura of the chest wall with at least one of the following features:
  • Involvement of the endothoracic fascia
  • Involvement of the mediastinal fat
  • Single focus of tumor involving the soft tissue of the chest wall
  • Involvement of pericardium just on the out aspect (without penetration of pericardium

  • T4: Tumor involves same side pleura of the chest wall with at least one of the following features:
  • Diffuse or multi-focal involvement of the soft tissue of the chest wall
  • Involvement of the rib
  • Invasion through the diaphragm to the peritoneal cavity
  • Invasion of any mediastinal organ
  • Direct extension to the pleura on the other side
  • Invasion into spine
  • Penetration of the pericardium
  • Pericardial effusion which is positive for cancer cells
  • Involvement of heart muscle
  • Involvement of the nerves of brachial plexus

  • Lymph node involvement (N)
    NX: Regional lymph nodes cannot be assessed
    N0: No regional lymph node involvement
    N1: Involvement of same side bronho-pulmonary and or hilar lymph nodes only
    N2: Involvement of subcarinal lymph node(s), and or same side or opposite side internal mammary or mediastinal lymph node(s)
    N3: Involvement of opposite side mediastinal, internal mammary, or hilar lymph node(s) and or same side or opposite side supraclavicular or scalene lymph node(s)

    Distant metastasis (M)
    Mx: Distant metastasis cannot be assessed
    M1: No distant metastasis
    M1: Distant metastasis present

    Stage 1
  • T1 N0M0

  • Stage IA
  • T1a N0M0

  • Stage IB
  • T1b N0 M0

  • Stage II
  • T2, N0 M0

  • Stage III
  • T1, T2 N1 M0
  • T1, T2, N2, M0
  • T3, N0, N1, N2, M0

  • Stage IV
  • T4 Any N M0
  • Any T N3 M0
  • Any T Any N, M1

  • Probably the most important prognostic factor in patients with mesothelioma may be the tumor burden. Prognosis in patients with small tumor and no involvement of lymph nodes are significantly superior compared to those with those patients who have bigger tumor size and involvement of the lymph nodes. Higher stage by itself is a poor prognostic factor in malignant mesothelioma. Further prognostic factors for mesothelioma will be discussed elsewhere in this article.

    Cancer terms:
    Metastasis: Cancer cells may travel through the blood stream or lymphatic system to organs that are far away from the initial tumor growth and may start a secondary growth. This phenomenon of cancer cells growing in places far away from the original tumor is called metastasis. For example breast cancer may progress with development of metastasis in the lungs, liver, bone or brain. See section on what is cancer? for more details. See cancer terms for more cancer related terms. Staging of pleural mesothelioma

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