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]

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. There is no established staging system for peritoneal mesothelioma.

TNM Calssification for Pleural Mesothelioma

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

• size and extent of the primary tumor
• number and location of any regional lymph nodes infiltrated by tumor cells
• whether the cancer metastasized to distant part of the body

TNM Classification	Definition
Primary Tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T3	Lymphoma penetrates the subserosa
T4	Lymphoma has grown through the serosa or invades organs near the stomach
T1a	Tumor invades subepithelial connective tissue, but has no lymphovascular invasion
T1b	Tumor invades subepithelial connective tissue and has spread to the lymphatic channels or blood vessels
T2	Tumor invades the erectile tissue (corpus spongiosum or cavernosum)
Regional Lymph Nodes (N)
N0	No cancer in regional lymph nodes
N1-3	There is cancer in the regional lymph nodes
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.

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.

References

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