Mesothelioma is a rare kind of cancer that primarily affects the outer covering of certain organs and cavities of the body. The vast majority of all mesothelioma cases are attributed to asbestos exposure with a mean cancer development period of between 20 and 50 years after the exposure to asbestos. Staging is a very important diagnostic classification in mesothelioma cases as it can provide an understanding of the current status of the cancer.
Like all cancers, doctors need to have a standardized way to communicate with each other the degree to which the mesothelioma has grown, proliferated, or has spread in the body in order to come up with a more definitive treatment plan. Depending on the stage of the mesothelioma, doctors can decide which treatment plan will work best on a particular patient with a particular stage of mesothelioma.
For example, a Stage I mesothelioma can still respond well to surgical methods especially when combined with directed and localized radiation therapy and a more systematic chemotherapeutic approach. This helps ensure better patient outcomes. On the other hand, a Stage IV mesothelioma cannot be treated with surgical or radiation therapies since the cancer cells may have already spread, or metastasized, to different parts of the body. This leads doctors to perform more radical approaches to treatment although the prognosis will remain poor.
As such, as a general rule, the lower the staging of the mesothelioma, the more varied the treatment options, and the better the patient outcomes. Conversely, the higher the staging of the mesothelioma, the more advanced the cancer, and hence, the poorer the prognosis.
Therefore, early mesothelioma detection is vital in order to ensure better patient outcomes. The earlier the mesothelioma is detected, the more treatment options are available. If the patient is healthy enough and the doctors agree that the mesothelioma can be safely resected – or surgically removed – then more aggressive treatments can be performed in order to ensure better patient outcomes and greater survival rates.
Presently, there are three methods used by doctors in the staging of mesothelioma. These include the Brigham Method, the Butchart Method, and the TNM Method. These methods are often used for the staging of pleural mesotheliomas with the Brigham and the TNM being the most commonly used.
The Brigham Method is the easiest to use because it only considers the localization of the primary tumor and whether it has already spread to adjacent lymph nodes. The Brigham Method uses Stage I-IV for its classification system.
In the TNM Method, mesothelioma staging takes into consideration the size and location of the primary tumor (T), the involvement of lymph nodes (N), and whether metastasis has already occurred (M). Each of the letters T, N, and M are given numerical values to describe the severity of the mesothelioma. So mesothelioma staging can be in the form of Stage I, Ia, Ib, II, III, and IV.
The Butchart Method follows the same principles as in the Brigham and TNM systems. The Butchart is the oldest method of staging mesotheliomas, particularly the pleural type.
Generally, Stage I mesothelioma has the highest favorable patient outcomes. Surgery is highly possible and is considered the most effective mesothelioma treatment. The tumor cells have not yet fully spread to more distant areas of the body and are generally considered to be close to the primary mesothelioma tumor. While it is possible that the tumor may have begun spreading into the lining of the diaphragm and the heart, it is nevertheless a lot easier to surgically remove. The challenge, however, is that a person with mesothelioma generally does not have enough manifestations of symptoms that will point to the possibility of mesothelioma at this stage in time. Therefore, diagnosis can only be confirmed if the patient firmly believes he has mesothelioma. With aggressive therapy – a combination of surgery, radiation therapy, and chemotherapy – patients who are diagnosed with Stage I mesothelioma can live up to 21 months after successful treatment. Again, this is just a median life expectancy.
In Stage II mesothelioma, the tumor cell has already begun to spread and clinical manifestations may already be evident. The problem is that many of these symptoms are often interpreted as signs of other health conditions. For example, while dry cough can be a significant sign of pleural mesothelioma, it can also be a sign of other respiratory problems such as bronchitis, pneumonia, or even a simple upper respiratory tract infection. Nevertheless, if the mesothelioma is diagnosed at this time, surgery remains the best treatment option especially when combined with radiation therapy and chemotherapy. If treated by this time, the prognosis is currently around 19 months.
Once the mesothelioma tumor cell has spread to adjacent or nearby structures on the same side of the body where the primary tumor originates, the patient is said to be in Stage III mesothelioma. Here, the lymph nodes, ribs, esophagus, heart, and the chest wall may already be affected. The clinical manifestations become more aggressive often leading to chest pain and difficult breathing. Unfortunately at this point, many patients can no longer respond well to surgery. Doctors can provide palliative care which is designed to mitigate the associated health problems, particularly pain. In these cases, survival is down to 16 months.
3 out of 10 mesothelioma patients remain undiagnosed by Stage IV where the cancer has already spread throughout the body including the brain, the liver, and the bones leading to the development of other cancers in these areas. The goal of Stage IV mesothelioma therapy is to improve quality of life which includes the provision of optimum comfort through the effective management of pain and other symptoms. Unfortunately, chemotherapy can only prolong the life and relieve the symptoms for several months. Survival dwindles down to not more than 12 months on average.
Mesothelioma is rare yet deadly. Early detection and treatment provide the best hope of survival. Understanding the different stages of mesothelioma can hopefully provide better understanding of treatment options.