Malignant Pleural Mesothelioma Stages

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To evaluate the prevalence of tumors in Malignant Pleural Mesothelioma there are three staging systems.

  • Butchart Staging System: The oldest system and not used anymore (Table 1)
  • Brigham Staging System: The most used system (table 2) before TNG system developed by IMIG (International Mesothelioma Interest Group)
  • TNG Staging System: Widely accepted and the latest staging system by created by IMIG (International Mesothelioma Interest Group)

Table 1 – Butchart Staging System for Malignant Pleural Mesothelioma

Stage 1Tumors is confined within the parietal pleural capsule, e.g. ipsilateral pleura, lung, pericardium and diaphragm involvement
Stage 2 Tumors invaded the chest wall or mediastinal structures (esophagus, heart, contralateral pleura, lymph nodes)
Stage 3Tumors penetrated diaphragm, peritoneum and contralateral pleura, extra-chest lymph node involvement
Stage 4 Tumors has distant metastasis / metastases

Table 2 – Brigham Staging System for Malignant Pleural Mesothelioma

Stage 1Tumors are only in the lining of the lungs and cancer has not spread to the lymph nodes. Surgery is an option.
Stage 2 Tumors are within the lining of the lungs. Lymph nodes near the tumors are cancerous. Surgery is an option.
Stage 3 Inoperable tumors are in the lining of the lungs and have spread into one or more organs
Stage 4Tumors has spread to distant parts of the body. Surgery is not an option

Table 3 – TNM Staging System for Malignant Pleural Mesothelioma

T categoryDefinition
TxPrimary tumor not assessable
T0No evidence of primary tumor
T1
   T1aTumor involving the ipsilateral parietal pleura (including mediastinal and diaphragmatic pleura) without involvement of visceral pleura
   T1bTumor involving the ipsilateral parietal pleura (including mediastinal and diaphragmatic pleura) with focal involvement of visceral pleura
T2Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura) with at least one of the following features:
– Confluent visceral pleural tumour (including the fissures)
– Involvement of diaphragmatic muscle
– Invasion of the lung parenchyma
– Confluent visceral pleural tumour (including the fissures)
– Involvement of diaphragmatic muscle
– Invasion of the lung parenchyma
T3Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura) with at least one of the following features:
– Invasion of the endothoracic fascia
– Extension into the mediastinal fat
– Solitary, completely resectable focus invading soft tissues of the chest wall
– Non-transmural involvement of the pericardium
– Invasion of the endothoracic fascia
– Extension into the mediastinal fat
– Solitary, completely resectable focus invading soft tissues of the chest wall
– Non-transmural involvement of the pericardium
T4Tumor involving all of the ipsilateral pleural surfaces with at least one of the following features:
– Diffuse or multifocal invasion of soft tissues of the chest wall
– Any rib involvement
– Invasion of the peritoneum through the diaphragm
– Invasion of any mediastinal organ
– Direct extension to the contralateral pleura
– Invasion of the spine or brachial plexus
– Transmural invasion of the pericardium (with or without pericardial effusion) or myocardium invasion
– Diffuse or multifocal invasion of soft tissues of the chest wall
– Any rib involvement
– Invasion of the peritoneum through the diaphragm
– Invasion of any mediastinal organ
– Direct extension to the contralateral pleura
– Invasion of the spine or brachial plexus
– Transmural invasion of the pericardium (with or without pericardial effusion) or myocardium invasion
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