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.
T2 Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following:
T3 Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following:

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:
  • Diffuse or multifocal invasion of soft tissues of the chest wall
  • Rib involvement
  • Invasion through the diaphragm and into the peritoneum
  • Invasion of any organ in the mediastinum
  • Extension to the contralateral pleura
  • Invasion into the spine
  • Extension to the internal surface of the pericardium
  • Pericardial effusion with positive cytology
  • Invasion of myocardium
  • Invasion of nerves of the brachial plexus

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.
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 cancer.

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.

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:

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:

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:

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:

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:

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:

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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