Mesothelioma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2], Sujit Routray, M.D. [3]

Overview

According to the Union for International Cancer Control staging system, there are four stages of pleural mesothelioma based on the primary tumor, lymph nodes, and metastasis: stage I (IA, IB), stage II, stage III, and stage IV. There is no established staging system for peritoneal mesothelioma.

Staging

According to the Union for International Cancer Control staging system, there are four stages of pleural mesothelioma based on the primary tumor, lymph nodes, and metastasis.[1] There is no established staging system for peritoneal mesothelioma.

TNM Classification for Pleural Mesothelioma

TNM stands for tumor, nodes, and metastasis. TNM staging describes:[1]

TNM Classification Definition
Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor involves the ipsilateral parietal pleura, with or without focal involvement of the visceral pleura.
  • T1a – Tumor involves the ipsilateral parietal pleura and may also be in the pleura lining the diaphragm or the mediastinum. There is no tumor in the visceral pleura.
  • T1b – Tumor involves both the ipsilateral parietal pleura and the visceral pleura.
T2 Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following:
  • tumor in the visceral pleura, including the fissures of the lung
  • invasion of the diaphragm
  • invasion of the lung parenchyma
T3 Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following:
  • invasion of the endothoracic fascia
  • invasion into mediastinal fat
  • solitar tumor invading soft tissues of the chest wall
  • non-transmural involvement of the pericardium

T3 describes mesothelioma that is locally advanced, but potentially resectable

T4 Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following:

T4 describes mesothelioma that is locally advanced, but unresectable

Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in either or both the ipsilateral bronchopulmonary lymph nodes and the hilar lymph nodes.
  • Bronchopulmonary lymph nodes are within the lungs.
  • Hilar lymph nodes are near where the bronchus enters the lung.
N2 Metastasis in ipsilateral subcarinal lymph nodes and in either the internal mammary lymph nodes or mediastinal lymph nodes on the same side.

OR
Metastasis in subcarinal lymph nodes or in either the internal mammary lymph nodes or mediastinal lymph nodes on the same side of the chest as the cancer.

  • Subcarinal lymph nodes are below the trachea.
  • Internal mammary lymph nodes are around the sternum.
  • Mediastinal lymph nodes are in the mediastinum.
N3 Metastasis in the contralateral mediastinal lymph nodes, internal mammary lymph nodes, or hilar lymph nodes and in either the supraclavicular lymph node or scalene lymph nodes on the ipsilateral or contralateral side.

OR
Metastasis in the contralateral mediastinal, internal mammary, or hilar lymph nodes or in either the supraclavicular or scalene lymph nodes on the ipsilateral or contralateral side.

  • Supraclavicular lymph nodes are located above the clavicle.
  • Scalene lymph nodes are located at the base of the neck.
Distant Metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

UICC Staging for Pleural Mesothelioma

The UICC further groups the TNM data into the stages listed in the table below.[1]

UICC Stage TNM Explanation
Stage IA T1a N0 M0 Mesothelioma in the pleural layer that lines the chest wall on ipsilateral parietal pleura.

It does not involve the visceral pleura. It has not spread to lymph nodes or distant organs.

Stage IB T1b N0 M0 Mesothelioma in the parietal pleura with focal tumors on the visceral pleura on one side of the chest.

It has not spread to lymph nodes or distant organs.

Stage II T2 N0 M0 Mesothelioma in any of the pleural surfaces (parietal pleura, pleura lining the mediastinum or diaphragm, and visceral pleura) on one side of the chest. It has also grown into at least one of the following:
  • the visceral pleura that covers the fissures of the lung
  • the diaphragm
  • the lung itself It has not spread to lymph nodes or distant organs

It has not spread to lymph nodes or distant organs.

Stage III T1,
T2
N1 M0 Mesothelioma in the parietal pleura, the visceral pleural, or both, on one side of the chest. It may or may not have grown into at least one of the following:
  • the diaphragm
  • the lung itself

It has spread to the lymph nodes on the same side of the chest as the mesothelioma. These lymph nodes that contain cancer may be:

  • bronchopulmonary lymph nodes
  • hilar lymph nodes
  • in both locations

It has not spread to distant organs.

T1,

T2

N2 M0 Mesothelioma in the parietal pleura, the visceral pleural, or both, on one side of the chest. It may or may not have grown into at least one of the following:
  • the diaphragm
  • the lung itself

It has spread to the lymph nodes on the same side of the chest as the mesothelioma. The lymph nodes that contain cancer may be:

  • subcarinal lymph nodes
  • internal mammary lymph nodes
  • mediastinal lymph nodes
  • subcarinal lymph nodes and internal mammary lymph nodes or mediastinal lymph nodes

It has not spread to distant organs.

T3 N0,

N1,
N2

M0 Mesothelioma involves any of the pleura on one side of the chest and has grown into at least one of the following:
  • endothoracic fascia
  • the fatty part of the mediastinum
  • a single area of soft tissue of the chest wall, such as muscle or fat
  • pericardium

It may or may not have spread to lymph nodes closest to the ipsilateral lung, trachea, sternum, or mediastinum.
It has not spread to distant organs.

Stage IV T4 any N M0 Mesothelioma involves any of the pleura on one side of the chest and has grown into at least one of the following:
  • several areas of soft tissue of the chest wall
  • rib
  • the diaphragm and into the peritoneum
  • mediastinum
  • contralateral pleura
  • spine
  • pericardium
  • pericardial effusion positive for cancer cells
  • myocardium
  • brachial plexus

It may or may not have spread to lymph nodes. It has not spread to distant organs.

any T N3 M0 Mesothelioma is any size and may or may not have grown into nearby tissues or organs.

It has spread to lymph nodes in one of the following locations:

  • contralateral mediastinal, internal mammary, or hilar lymph nodes
  • ipsilateral or contralateral supraclavicular or scalene lymph nodes
  • contralateral mediastinal, internal mammary, or hilar lymph nodes and to supraclavicular or scalene lymph nodes on either side

It has not spread to distant organs.

any T any N M1 Mesothelioma of any size and may or may not have grown into nearby tissues or organs.

It may or may not have spread to the lymph nodes.
It has spread to distant organs.

Gallery

References

  1. 1.0 1.1 1.2 Stages of pleural mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/staging/?region=on. Accessed on February 6, 2016
  2. 2.0 2.1 Anatomy and physiology of the mesothelium. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/anatomy-and-physiology/?region=on. Accessed on February 16, 2016


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