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Stages of Mesothelioma

Mesothelioma is an aggressive cancer that is caused by exposure to asbestos. The mesothelioma cells grow due to asbestos fibers that cause inflammation and irritation in the body. This cancer has been found in various parts of the body, but it mainly occurs in the lining of the lungs or abdomen.

Asbestos is a mineral used to create insulation for buildings and other structures. People also used it to make many products like roofing, ceiling tiles, flooring, etc. In addition to these products, asbestos was also an ingredient in paints, plastics, pottery glazes, and textiles.

The first symptom of mesothelioma usually appears 20-60 years after a person is exposed to asbestos.

There are typically four mesothelioma stages, which help doctors determine the severity of the cancer.

Key Facts About Mesothelioma

  • In the United States, doctors diagnose around 3,000 new cases each year.
  • There are four types of mesothelioma; pleural (lungs), peritoneal (abdominal wall and pelvic cavity), pericardial (heart), and testicular.
  • The incidence rate of mesothelioma has decreased in the United States in recent years, where the use of asbestos became strictly regulated in 1986.
  • It can take anywhere from 20 to 60+ years for symptoms of mesothelioma to develop after asbestos exposure.
  • The highest incidence rate reported is from the UK at 3.6 and 0.7 cases per 100,000 people for men and women, respectively.
  • It is more common in men than women, likely due to historical workplace differences. 
  • More than 3 out of 4 mesotheliomas are pleural mesotheliomas.
  • Medical experts estimate that there will be 300,000 cases of mesothelioma before the year 2030.

Risk Factors for Mesothelioma

According to the Centers for Disease Control and Prevention, some risk factors for mesothelioma include:

  • exposure to asbestos in the workplace
  • living with someone who is regularly exposed to asbestos
  • coming into contact with disturbed building materials that contain asbestos
  • living in an area where there are asbestos mines, factories, or natural asbestos deposits

Types of Mesothelioma

There are four different types of mesothelioma.

  • The pleura (or outer lining of the lung) is the thin membrane that covers all these structures and exists between the chest cavity and the lungs.
  • The peritoneum covers most of the internal organs in the abdomen.
  • The pericardium is a sac-like membrane that surrounds and protects the heart.
  • The tunica vaginalis lines the testicles.

What Are The Stages of Mesothelioma? 

Mesothelioma is classified into two stages: localized and advanced. In localized mesothelioma, the tumor is still contained within the initial region and has not spread to other body parts. Advanced mesothelioma occurs when tumor cells have spread to other organs or parts of the body such as the lungs, stomach, or brain.

However, some specific staging systems allow doctors to diagnose mesothelioma more effectively.

Stages of Pleural Mesothelioma

Malignant pleural mesothelioma is one type of mesothelioma. It begins in the pleura, which lines your entire respiratory system and the inside of your chest wall.

Symptoms may include:

  • chest pain
  • coughing
  • decreased appetite
  • difficulty swallowing
  • fatigue
  • fluid buildup (effusion) in the lung
  • hoarseness
  • lumps under the skin on the chest
  • pain in the side of the chest or lower back
  • shortness of breath
  • swelling of the face and arms
  • weight loss without trying

For pleural mesothelioma, there are several different staging systems that doctors can use to determine the severity of the cancer.

The TNM Staging System

The American Joint Committee on Cancer (AJCC) TNM system is the leading and most commonly used staging system. This staging system is based on three key pieces of information:

  • T: the position and size of the primary mesothelioma tumor
  • N: whether the mesothelioma cells have spread to nearby lymph nodes
  • M: whether the mesothelioma cells have spread (metastasized) to other parts of the body

The T Category

Doctors then assign a letter or number to the T category for further information.

Letters they may assign include:

  • TX means there is no information about the primary tumor, or doctors can’t measure it.
  • T0 means no evidence of a primary tumor (doctors cannot locate it).
  • Tis is where the cancer cells are only growing in the layer of cells where they started and not deeper down. This may be called ‘in situ’ or ‘pre-cancer’.

In situ is a term used to describe cancer cells that cannot spread past the layer of cells they began in. This means that the cancer cells only grow in the original layer without spreading into deeper layers. 

Doctors may also assign numbers to the T category.

Tumor size and how much it has spread are important factors in determining the grade of the tumor. Higher T numbers (such as T3 or T4) indicate a larger tumor or that it has grown into other nearby structures.

The N Category

The N category can be assigned a letter or a number:

  • NX means the nodes near the area where the tumor is can’t be assessed, or there is no information about them.
  • N0 means nearby lymph nodes do not contain cancer.
  • Doctors might use the number assigned to the N category to provide information about how many nearby lymph nodes have been affected by the cancer or its size or location. These numbers are typically N1, N2, N3, or N4.

The higher the N number, the greater the cancer spread to nearby lymph nodes.

The M Category

Doctors assign a number to the M category:

  • M0 indicates that they have not found the tumor to have spread.
  • M1 means that the cancer has reached distant areas of the body.

This information is combined to determine which cancer stage to diagnose.

The Butchart Staging System

Another commonly used staging system is the Butchart system. Dr. Eric G. Butchart created this system in the 1970s. 

It has four stages.

  • Stage 1: The cancer is in one side of the pleural membrane or sometimes the pericardium, diaphragm, or lung on the same side. It has not spread to nearby lymph nodes or further.
  • Stage 2: Cancer cells are present in the esophagus, both sides of the pleura, or the heart. The cancer might also have spread to the chest or lymph nodes.
  • Stage 3: The cancer has spread to the peritoneum via the diaphragm. The cancer may also be found in other lymph nodes that are not located inside the chest cavity.
  • Stage 4: The cancer has spread through the body to other organs, such as a person’s bones, brain, or liver.

This staging system helps doctors determine the best treatment plan for their patients. They can also provide a prognosis for the mesothelioma patient.

The Brigham Staging System

The final commonly used staging system is the Brigham system. This was created by Dr. David Sugarbaker and his colleagues at Boston’s Brigham and Women’s Hospital in 1993. They then revised it in 1998. 

This system uses factors such as whether surgery can remove the cancer and if it has spread to lymph nodes.

It has four stages.

  • Stage 1: There are no cancerous lymph nodes in the body, and doctors can surgically remove the malignant mesothelioma.
  • Stage 2: There are signs of cancer in the lymph nodes. However, surgery can still remove the tumor.
  • Stage 3: The cancer has spread to other body parts, including the chest wall, through the diaphragm to the peritoneum, or the heart. It may not have spread to lymph nodes, but it is not possible to remove the cancer with surgery at this stage.
  • Stage 4: The cancer has spread through the body to other organs, such as a person’s bones, brain, or liver.

This system allows doctors to determine if surgery is an option for their patients. Alternatively, they can give an accurate prognosis and determine which other treatment path they should pursue. 

Stages of Peritoneal, Pericardial, and Testicular Mesothelioma

There are three other types of mesothelioma: peritoneal, pericardial, and testicular. 

Peritoneal mesothelioma is when the cancer develops in the lining of the abdominal cavity. It is called pericardial mesothelioma when it grows in the sac around the heart and lungs. Testicular mesothelioma occurs when the cancer forms in the tissues around the testicles.

Peritoneal Mesothelioma 

Peritoneal Mesothelioma is a rare form of cancer affecting the abdomen’s lining. It most often occurs in people exposed to asbestos, and it can take 20-60+ years after exposure for symptoms to appear.

The symptoms of peritoneal mesothelioma are often vague and may mimic other diseases. The most common symptoms are:

  • abdominal pain
  • abdominal swelling
  • decreased appetite
  • fatigue
  • fever
  • fluid build-up in the abdomen (ascites)
  • irregular bowel movements
  • nausea or vomiting
  • night sweats
  • weight loss without trying

Although there is no widely accepted staging system for peritoneal cancer, doctors diagnosing peritoneal mesothelioma may use the PCI staging system

The peritoneal cancer index (PCI) is a scoring system for peritoneal mesothelioma that divides the abdomen and pelvis into 13 regions, with each region given a score between 0 and 3. The PCI is calculated by adding the scores for all 13 areas, with a higher score indicating the cancer has spread further.

Sometimes the doctors may use the TNM system commonly used for pleural mesothelioma.

Pericardial Mesothelioma

The pericardium is a sac that surrounds the heart and keeps it from moving too much. Pericardial mesothelioma is a rare type of cancer that develops on the lining of this sac. 

Symptoms include:

  • chest pain
  • fatigue
  • heart murmur
  • irregular heart rhythm
  • shortness of breath
  • weight loss without trying

This cancer does not have its own staging system, but sometimes doctors may use the TNM system.

Testicular Mesothelioma

Testicular mesothelioma is a type of mesothelioma that starts in the cells that line the testicles. 

Symptoms may include:

  • a lump in the testicle
  • blood in semen or urine
  • pain in the testicle
  • swelling in the testicle

Because this cancer is so rare, there is no widely accepted staging system for it.


Read on for the answers to some commonly asked questions about mesothelioma.

Where does mesothelioma start?

Mesothelioma is a type of cancer that starts in the mesothelial cells. These cells are found in the lining of many organs, including the lungs. Mesothelioma can begin anywhere in the body where there are mesothelial cells. It is most often found in the lining of the lungs and abdomen, but people can also find it in other parts of the body. It is associated with asbestos exposure.

How quickly does mesothelioma progress?

The progression of mesothelioma can vary from person to person. The progression rate depends on several factors, including the type and location of cancer cells, the amount of asbestos exposure, and the age at which an individual is diagnosed.

Is mesothelioma always fatal?

Unfortunately, yes, mesothelioma is considered to be a fatal disease with not cure.  However, the prognosis for mesothelioma differs depending on how far it has progressed and which organs it affects. While there is no cure for mesothelioma, a diagnosis in earlier stages may make certain treatment options available that can prolong a patient’s life and make the side effects more manageable.  

How does mesothelioma staging affect treatment?

A doctor stages mesothelioma based on the size and location of the tumor, whether the cancer has spread to nearby lymph nodes or organs, and whether there are symptoms. Mesothelioma staging is the doctor’s way of determining how far the cancer has progressed. The higher the stage, the more aggressive the treatment should be.

Contact Bailey Glasser Today

Mesothelioma is a rare but aggressive form of cancer. It is caused by inhaling or ingesting tiny particles of asbestos, which can also lead to lung cancer and other fatal diseases. The average lifespan following diagnosis is one year, but the prognosis can greatly depend on the type and stage of mesothelioma. Early detection is vital for getting the best prognosis possible.

Detecting mesothelioma as soon as possible can extend your life and allow you time to file a compensation claim. To receive a diagnosis, speak to your primary care physician about your symptoms. Be sure to mention if you’ve worked around asbestos in the past.

At Bailey & Glasser, LLP, we understand how devastating a mesothelioma diagnosis is for patients and their families. Our attorneys can help connect patients and their families to vital resources and help secure the financial compensation they need to move forward. If you’ve been exposed to asbestos in the past, you may be entitled to compensation if you have symptoms of mesothelioma.