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The four stages of mesothelioma allow doctors to identify and classify the severity and progression of the cancer at diagnosis. Stage 1 offers the most hopeful prognosis, while a Stage 4 diagnosis often means the patient is limited to palliative care.
Mesothelioma staging refers to the process of categorizing mesothelioma according to the extent of the disease in a patient’s body. Staging is actually a process common to all types of cancer, although specific staging systems are often developed based on characteristics of specific cancers, like mesothelioma.
Mesothelioma has four stages that doctors can use to determine extent of the cancer within the body. Upon being diagnosed, the diagnosing doctor will identify the stage with a number between 1 and 4, with Stage 4 being the most severe and deadliest form.
Mesothelioma arises many years after exposure to asbestos, usually between 20 and 40 years after the asbestos exposure occurred. Mesothelioma can be caused by exposure to Asbestos in the workplace, at home or even through personal contact with someone who has been exposed to asbestos dust and has asbestos dust contaminating their clothing and person. Mesothelioma can arise after only brief, incidental exposures to asbestos. According to the Occupational Safety and Health Administration (OSHA), the National Institute of Occupational Safety and Health (NIOSH), the Environmental Protection Agency (EPA) and the International Agency for Research on Cancer (IARC), there is no known safe level of exposure to Asbestos—that is, there is no level of exposure that does not increase the risk of mesothelioma. Mesothelioma caused by Asbestos exposure has been found to occur not only in workers who used Asbestos containing materials or were around Asbestos containing dust, but in their wives and children who were exposed to Asbestos dust from their loved one’s clothing.
If you or a loved one are experiencing symptoms, consult with a physician with experience in diagnosing mesothelioma as soon as possible. The earlier mesothelioma is definitively diagnosed, the more treatment options may be available. Additional mesothelioma information and statistics can be found in this section.
Mesothelioma Staging by Type
Given the rarity of mesothelioma, a formal staging classification exists only for pleural mesothelioma, the most common variety. No formal staging systems are defined for peritoneal, pericardial, or testicular mesothelioma.
Although there are no staging systems for less common forms of mesothelioma, the American Joint Committee on Cancer (AJCC) has published general guidelines for staging cancer in its AJCC Cancer Staging Manual. Therefore, even when doctors do not have guidelines for a specific form of cancer, they can still refer to the general guidelines to help determine the stages of extremely rare cancers like peritoneal mesothelioma and pericardial mesothelioma.
Staging only occurs at diagnosis. While the cancer may progress or recede, the stage of mesothelioma at diagnosis will not change. For example, if a Stage 1 mesothelioma tumor spreads to other parts of the body, it is called Stage 1 with metastasis. Likewise, if a Stage 4 mesothelioma tumor reduces in size or goes into remission, the stage will not change. While the initial treatment program may depend on the mesothelioma stage, actual treatment may vary depending on how the disease progresses.
Generally, staging requires a number of diagnostic tests to determine the tumor location, size, and whether it has spread beyond the initial site.
Stages of Mesothelioma
The four stages of mesothelioma vary slightly within each system, but they can be generalized as indicated below. Please click into the individual pages to get more information about each stage.
In Stage 1, the mesothelioma tumor is in one location, and the cancer has not spread to lymph nodes or other organs or tissues. In general, surgery may be an option for removing the tumor.
In Stage 2, the mesothelioma tumor is larger and has invaded nearby organs, such as the lung or diaphragm. Lymph nodes may also be involved. In this case, surgical resection may still be possible, though more difficult depending on the extent of the growth.
In Stage 3, mesothelioma has invaded a region or area, such as the chest wall, esophagus, or lymph nodes. Surgery is generally not an option as a curative treatment, though other treatments may be tried.
In Stage 4, the mesothelioma has spread to multiple areas, such as other organs and tissues throughout the body. Surgery is not an option, and most treatments at this stage focus on reducing pain and discomfort.
Types of Mesothelioma
Pleural mesothelioma arises in the membrane which surrounds the lung, called the pleura. Pleural mesothelioma is the most common form of this deadly cancer.
Peritoneal mesothelioma develops in the lining of the abdominal cavity, called the peritoneum. Peritoneal mesothelioma is less common but is more often found in women than in men.
Pericardial mesothelioma originates in the pericardium, which lines the heart.
Once a definitive diagnosis of mesothelioma has been rendered, treatment options should be aggressively explored with qualified mesothelioma expert physicians. There have been medical breakthroughs in treating mesothelioma through surgery, radiation therapy and certain chemotherapy. Several surgeons have pioneered progressive surgical options for mesothelioma victims, including Dr. Harvey Pass, (NYU Langone Cancer Center), Dr. David Sugarbaker (Baylor College of Medicine) and Dr. Raphael Bueno (Brigham and Women’s Hospital). Research on the most effective chemotherapy regimens continues and to date Alimta and Cisplatin have been shown to be very helpful in some patients.
Clinical trials and experimental treatment protocols are available to some Mesothelioma victims. Certain non-conventional alternative therapies are being studied and may provide some benefit to patients with Mesothelioma. Because Mesothelioma is such a rare and lethal type of cancer, it is essential to discuss all available treatment options with the treating internists, pulmonologists, oncologists and surgeons. Please see the links below for additional information on the top medical mesothelioma experts in the United States and for a listing of the most prestigious and progressive cancer treatment centers.
Pleural Mesothelioma Staging Systems
Over the years, different systems have been developed to stage mesothelioma. The three most commonly used systems are very similar, although they vary slightly. Learn more about each staging system for mesothelioma by selecting the appropriate link below.
Note that mesothelioma-specific staging systems only exist for pleural mesothelioma. Other types of mesothelioma do not have their own staging systems.
Butchart Staging System
The Butchart staging system is the oldest and most commonly used staging system for mesothelioma. This system focuses on defining the location of the primary tumor mass in the body for each stage. The system doesn’t address how many cancer cells are present, how big the tumor is, or the overall amount of cancer present in the body.
TNM Staging System
The TNM Staging System, developed by the American Joint Committee on Cancer (AJCC), is a staging system used for many different types of cancer. The current version of the TNM Staging System is detailed in the AJCC Cancer Staging Manual (7th ed., 2009). It considers the characteristics of the tumor (T), involvement of the lymph nodes (N), and whether the cancer has metastasized (M) to other locations within the body.
Brigham Staging System
The Brigham Staging System also has four stages of progression. The primary difference of the Brigham System from the others is that, in addition to identifying tumor characteristics and metastasis, the Brigham System assesses the likely success of surgical intervention at each stage.
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Asbestos Exposure & Cancer
Asbestos exposure is the primary proven cause of mesothelioma. Asbestos dust and particles that have been inhaled or ingested decades before cause inflammation and disruption of normal cell growth on a microscopic level leading to the development of mesothelioma cancer. Thousands of industrial, commercial and consumer products were manufactured with asbestos from the 1940’s through the 1990’s in some cases. Even though the asbestos companies knew that asbestos caused devastating diseases, including lung cancer and mesothelioma, they continued to use asbestos as an ingredient in products even when safer alternatives were available.
Almost all asbestos exposure that causes mesothelioma today originate from these thousands of asbestos containing products. Individuals who worked in industries like steel mills, foundries, power plants, chemical plants, refineries, paper mills, glass manufacturing, iron smelting and aluminum manufacturing from the 1940s through the 1990’s were most likely subjected, often unknowingly, to exposure to asbestos dust from asbestos containing products used in these industries. In addition, construction workers including laborers, insulators, brick layers, electricians, machinists, millwrights, plumbers, pipefitters, steamfitters, iron workers, boilermakers, carpenters, plasterers, drywall workers and even superintendents, engineers and architects who worked in commercial, residential or industrial construction from the 1940’s through the 1990’s were most likely exposed to Asbestos dust form the numerous asbestos containing construction materials sold by the asbestos companies.
The likelihood of being exposed to asbestos in these settings unfortunately does not decrease even if a worker never personally handled asbestos containing products—working in the same area where others’ work with asbestos products created asbestos dust that could be inhaled or ingested caused these works to experience dangerous levels of exposure to asbestos. Because the asbestos companies which sold the asbestos products did not provide warnings to the workers, many workers unwittingly introduced asbestos dust into their homes on their contaminated work clothing, subjecting their wives and even their children to enough asbestos exposure to cause mesothelioma. It has recently been found that common talcum powders, including baby powder, shaving powders, cosmetic and hygiene talcum powders, contained dangerous levels of asbestos sufficient to cause mesothelioma.
Mesothelioma Stages Are Guides – Not Rules!
Although the stage of the mesothelioma can provide guidance about the expected course of the disease (that is, the prognosis) it is important to remember that the staging systems themselves are guides. At every stage, mesothelioma can be deadly – but there can also be some hope as well, no matter what stage you are diagnosed at.
Every patient’s treatment options will depend heavily not only on the stage of the disease, but on the cell type and location of the mesothelioma they have, as well as the patient’s age, gender, and overall health.
If you or a loved one was recently diagnosed with mesothelioma, you may want to talk with someone who can provide explanation and context around your diagnosis. Contact us to connect with an expert who can help you understand what your stage means.
Common Mesothelioma Symptoms by Type
Chronic Obstructive Pulmonary Disease (COPD)
Adenocarcinoma and other lung cancers
Irritable Bowel Syndrome (IBS)
Other cancers affecting abdominal organs
Coronary artery disease
Other heart-related cancers, such as synovial sarcoma
Top Mesothelioma Doctors
Only the best, just for you.
Dr. Raphael Bueno is the Chief, Division of Thoracic Surgery and Vice Chair of Surgery for Cancer and Translational Research at Boston’s Brigham and
Dr. Harvey Pass is a renowned thoracic surgeon that has dedicated his career to bringing increased awareness of the dangers of asbestos exposure.
Dr. Robert Brian Cameron currently serves as the Director of Thoracic Oncology at University of California, Los Angeles School of Medicine, Department of Surgery.
Dr. David Sugarbaker is a world-renowned doctor and certified thoracic surgeon widely credited for developing the first tri-modal treatment approach for malignant pleural mesothelioma.
Dr. Lary A. Robinson is currently the Director of the Division of Cardiovascular and Thoracic Surgery at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.
As director of the mesothelioma program at the M.D. Anderson Cancer Center at the University of Texas in Houston, Anne Tsao M.D. is one of the nation’s foremost authorities on malignant mesothelioma.
Mesothelioma is Commonly Misdiagnosed
Mesothelioma is often misdiagnosed, at least initially, partly due to the fact that many mesothelioma symptoms resemble the symptoms of other diseases. Also, because mesothelioma is so rare, doctors may be more inclined to diagnose a more common disease first, thereby delaying treatment. Misdiagnosis can differ depending on the form of mesothelioma a patient may have. The table below provides common misdiagnoses based on mesothelioma type.
Treatment Options By Mesothelioma Stage
Stage 1 Mesothelioma Treatment
Mesothelioma surgery is the most commonly recommended course of treatment for pleural mesothelioma patients having a Stage 1 diagnosis. The procedures that are likely to be performed are pleurectomy/decortication or extrapleural pneumonectomy. Post surgery, doctors may further evaluate the patient to determine if chemotherapy or radiation treatment is necessary. It is often determined with stage 1 mesothelioma that those adjunct therapies are not required.
Stage 2 Mesothelioma Treatment
Patients diagnosed with Stage II Mesothelioma still have a fairly wide range of treatment options available to them. Chemotherapy and radiation therapy are the most common treatments that will be recommended. Surgery may or may not continue to be a viable treatment option at this stage. There are also a variety of experimental and alternative treatments that may be used to slow the progression of the disease and help manage the pain and stress associated with conventional treatment therapies.
Stage 3 Mesothelioma Treatment
The treatment options for Stage III Mesothelioma patients are fewer than those available for Stage I and II patients as the cancer, in this stage, has typically spread beyond the point of origin to other vital organs in the body or the lymphatic system. Treatments recommended for Stage III patients are primarily focused on providing patient comfort and improving quality of life.
Stage 4 Mesothelioma Treatment
A diagnosis of stage 4 mesothelioma usually indicates a very unfavorable mesothelioma prognosis. At this stage, the cancer has usually metastasized throughout the body to other organs and as with stages 2 and 3, cannot be cured. In this stage, symptoms generally increase in severity and pain management becomes the primary focus of the medical team. Therapies such as chemotherapy and radiation are typically not offered at this stage unless they are needed to support pain management objectives. Oftentimes families find that it is most helpful to seek out additional support through a local Hospice program. Hospice programs focus on providing patient care, developing a pain management protocol and providing support for both the patient and family members at this difficult time. Patients with stage 4 mesothelioma may also be interested in participating in specialized clinical trials offered at leading cancer hospitals and centers.
Costs Related to Mesothelioma
As with all types of cancer, Mesothelioma costs can be extremely high. The costs associated with the disease can be lumped into several categories: Diagnostic Testing Costs, Treatment Costs, Follow up and Recovery Expenses.
How much an family spends on mesothelioma care will likely depend on a variety of factors, such as the exact diagnosis, the stage when the disease is diagnosed, what is covered by insurance, and even where the patient resides.
Because asbestos is the only scientifically proven cause of pleural mesothelioma, those who are diagnosed with this deadly cancer may be able to receive for many different things, from lost income to medical costs, as well as damages for pain and suffering related to the disease. If you or a loved one has been diagnosed, you should strongly consider taking steps to help offset this potential financial burden.
Learn more about the financial assistance that is available if you or a loved one has been diagnosed with peritoneal mesothelioma. Financial aid options available to you can include mesothelioma trust funds as well as grants to cover travel, treatment and housing.
You can also explore your legal rights to compensation from asbestos companies liable for your exposure to asbestos.
Top Oncologists available to you.
We’ve collected a database of the Top Mesothelioma Doctors from around the country. Search for them here.