Mesothelioma Stages

Quick Summary

With mesothelioma, knowing what stage your condition has been diagnosed at is a major indicator of your prognosis, life expectancy and what to expect as part of your treatment plan. Specialists take the accurate staging of mesothelioma very seriously since it informs their treatment recommendations and ultimately their patient’s survival.

Mesothelioma Stages Overview

If you’ve recently been diagnosed with mesothelioma, here are the most important things to know about disease staging:

  • Staging is generally based on how far the mesothelioma has spread (metastasized)
  • Mesothelioma has stages 1-4, where stage 1 is localized and 4 where the cancer has spread to other parts of the body
  • Only pleural mesothelioma has an official staging system as it is more common than the other forms (peritoneal, pericardial and testicular)
  • Treatment options are available no matter what stage you are diagnosed at
  • Some mesothelioma doctors specialize in treating particular stages

What Are Mesothelioma Stages?

Mesothelioma stages are a rating system that doctors use to determine how far advanced the disease is.

When a patient is diagnosed with cancer, they’re not only diagnosed with the form of cancer but the stage as well. The stage at which you are diagnosed is every bit as important as the disease itself.

Mesothelioma Research Update

Mesothelioma researchers have devoted their lives to defining the disease’s stages. They’ve identified different criteria so that patients can receive the most targeted, effective treatments as possible.

Knowing the mesothelioma stage is essential because there are more treatment options available to someone diagnosed at stage 1 or 2 than there are to someone diagnosed at stage 3 or 4.

One of the major treatment decisions doctors make based on stage is whether someone is eligible for resectable surgery—removing the tumors.

Ultimately, mesothelioma stages help communicate to doctors the severity of the condition, which allows them to choose the right treatment and rule out other options. It’s also an important factor for patients to be aware of so they have a better understanding of what is happening and what they can expect.

Mesothelioma Staging Factors

Doctors look at a few key factors when determining the mesothelioma stage. All of these factors combined come together to paint a clearer picture of the severity of the disease. Looking at multiple factors gives doctors a realistic idea of the likely outcome of the disease. It’s important for patients to know that staging is a tool rather than a hard and fast rule.

Here are some of the factors doctors consider in mesothelioma staging:

  • Whether the mesothelioma is resectable (all visible tumors can be removed by surgery) or not
  • How far advanced the mesothelioma is
  • Mesothelioma cell type, which indicates how aggressively the disease spreads
  • Tumor shape, size, and behavior

Resectable vs. Unresectable

Resectable is a term cancer doctors use to describe the ability of tumors to be removed surgically.

If doctors feel there is a high probability that aggressive surgeries can remove all visible signs of the tumor, then they say the mesothelioma is “resectable”.

Whether doctors consider mesothelioma resectable also depends on the patient’s overall health level and age, as the healthier you are the more eligible you will be for surgery.

Typically, early stage mesothelioma is resectable through surgeries like the extrapleural pneumonectomy (EPP) or the pleurectomy with decortication (P/D). These are usually stages 1 and 2, and in some cases, stage 3 patients may also have resectable mesothelioma.

Stage 4 mesothelioma is rarely resectable, although these patients have other surgical options for unresectable mesothelioma. Doctors will recommend these palliative surgical options based on your unique case.

Localized vs. Metastasized

How far the mesothelioma has spread is the key factor in deciding whether the cancer is resectable or not. If the mesothelioma remains localized—meaning is stays confined it its primary location (the spot where it first developed)—then it’s considered early stage.

However, if the mesothelioma has spread to distant sites, such as to the nearby lymph nodes, chest wall or into the peritoneum (heart lining), then it’s considered advanced stage.

The process of cancer spreading to distant sites outside the primary location is called metastasis. When mesothelioma becomes metastatic, it’s almost impossible to remove it entirely.

Metastatic mesothelioma still has treatment options that are focused on pain management and keeping the patient as comfortable as possible. These treatments may also have some benefit for extending life as well.

What Mesothelioma Stages Tell Doctors

The mesothelioma stage tells doctors important information about the likely course of the disease and what can be done to control and/or stop the disease from spreading.

As a patient, it’s important for your overall mental wellbeing to know that doctors have thoroughly evaluated your condition. It gives you peace of mind in knowing that you’re receiving the best treatment options possible.

Here is what your mesothelioma stage can tell your healthcare team about your condition:

  • Treatment Goals and Options: The most important information that the mesothelioma stage provides is what type of treatment options are available. Generally, early-stage mesothelioma patients have more treatment options, including aggressive surgeries that remove organs in part or in full. The goals of early-stage cancer are to remove it, stop it from spreading and hopefully send it into remission. The goal of late-stage cancer is to make the patient as comfortable as possible by addressing all painful symptoms.
  • Prognosis: How advanced the mesothelioma is can tell doctors the likely course of the disease—the prognosis. A prognosis is a way to let patients know what they can expect in terms of timeline, how symptoms may worsen and what treatments they will eventually need to undergo as the disease progresses.
  • Life Expectancy: Patient life expectancy is largely determined by the mesothelioma stage. That’s because early stage mesothelioma is easier to treat, giving patients a better chance at long-term survival. Patients diagnosed with stage 1 mesothelioma have a 21-month or longer median life expectancy, while patients diagnosed with stage 4 mesothelioma have a 12-month median life expectancy.

Disease stage is only one aspect of a full and accurate diagnosis. Other aspects involved in a mesothelioma diagnosis include location and cell type. The location and cell type also help determine what treatments options are available as well as the disease prognosis and patient life expectancy.

Tests for Mesothelioma Staging

During diagnosis, doctors take several steps to better understand each patient’s unique case. Part of the diagnostic evaluation is understanding mesothelioma stage. Doctors use different tests to help them see exactly how far the mesothelioma has spread.

Here are some of the tests doctors may use when diagnosing your mesothelioma stage:

  • CT Scan: Computed Tomography scans take multiple x-ray pictures that doctors combine to create a 3D image of your chest or abdomen. These 3D images show doctors whether the mesothelioma tumor has spread into the chest wall or outside the abdomen and into the diaphragm.
  • MRI: Magnetic Resonance Imaging is a testing technique that uses magnetic fields to look inside organs. The image results can tell doctors which organs have been affected by mesothelioma and which treatment options they must pursue.
  • PET Scan: Positron Emission Tomography uses radioactive substances in the body to track different biological responses. PET scans help doctors see which parts of the body have been compromised by mesothelioma cells. PET scans are especially important for determining whether the lymph nodes have been infiltrated by mesothelioma cells.

Depending on the case, doctors may use one of these imaging techniques or multiple. The more images a doctor can obtain, the better his or her understanding of your disease will be.

Mesothelioma Staging System Types

Different experts have assembled different methods of determining cancer stage. Each staging system uses a different set of factors that measure the spread of cancer.

In mesothelioma diagnostics, 3 different staging systems are used:

  1. TNM Staging System: The most simple and commonly used staging system, TNM looks at the tumor (T), whether cancer cells have spread to the lymph nodes (N) and whether there has been metastasis (M).
  2. Butchart System: The original method of staging mesothelioma, the Butchart system determines the stage based on the tumor itself. Butchart staging assesses the location of the primary tumor, as opposed to other factors such as where mesothelioma cells have spread to.
  3. Brigham System: A 4-stage system developed by the late Dr. David Sugarbaker, the Brigham system ultimately determines which treatment options are available. The Brigham system is more comprehensive, taking into account tumor size, location, and spread. Based on this system, patients with stage 1 and 2 mesothelioma are eligible for resectable surgery.

Staging Available Based on Form of Mesothelioma

As of now, the only form of mesothelioma with official staging is pleural mesothelioma. Though a rare cancer, there have been enough cases of pleural mesothelioma for experts to recognize patterns in growth and be able to provide official staging.

Peritoneal, pericardial and testicular mesothelioma remains too rare to design an official staging system. Instead of diagnosing these other mesothelioma types at stage 1 through 4, doctors say whether the mesothelioma is early or advanced.

Doctors can still effectively treat patients simply by knowing the extent to which the cancer has spread. For example, early-stage peritoneal mesothelioma has a better prognosis than pleural mesothelioma because its primary resectable surgery option (cytoreduction surgery with HIPEC) is highly effective.

Seeking a Second Opinion from a Mesothelioma Specialist

If you’ve been diagnosed with mesothelioma, or you suspect you may have symptoms of it, then it’s important to see a mesothelioma specialist. There have been many cases of patients receiving a misdiagnosis from oncologists who didn’t have the experience necessary to identify their exact condition.

Sometimes, seeking a second opinion can result in an entirely different diagnosis, including a different disease stage.

To get in touch with the country’s top mesothelioma specialists, contact one of our Patient Advocates today. We work with mesothelioma patients every day to review their cases and help them get access to life-extending treatments.

Mesothelioma patients may also be eligible for legal compensation to help cover the costs of treatments and other expenses. Don’t delay in getting the treatment you deserve.

View Author and Sources

  1. Cancer Research UK, “Mesothelioma Stages” Retrieved from: Accessed on December 14, 2017.
  2. American Cancer Society, “How is Malignant Mesothelioma Staged” Retrieved from: Accessed on December 14, 2017.
  3. Winston W Tan, MD, FACP, “Malignant Pleural Mesothelioma Staging” Retrieved from Medscape. Accessed on December 14, 2017.

Last modified: January 25, 2019