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Mesothelioma Stages

Doctors employ the use of “stages” in both cancer diagnoses and monitoring to determine the progress of an individuals’ disease.  Staging takes a close look at cancers, like Mesothelioma, and determines to what extent it has developed and/or spread.  Most importantly, staging helps determine the course of treatment.

Currently, though there are three types of Mesothelioma – pleural, peritoneal, and pericardial – staging has thus far been established for the most frequently occurring form of this cancer - pleural - and not for the others. The three systems that stage this disease are the Butchart, TNM, and Brigham systems.

Butchart is the oldest system and is still the most commonly used.  Its four stages are based on the extent of primary tumor mass.
  • Stage I: Mesothelioma is present in the right or left pleura (the thin, transparent membrane which covers the lungs and lines the inside of the chest walls) and may also involve the diaphragm (the muscle separating the chest from the abdomen) on the same side.
  • Stage II: Mesothelioma invades the chest wall or involves the esophagus (food passage connecting the throat to the stomach, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
  • Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may now be affected as well.
  • Stage IV: There is evidence of metastasis (the spreading of the Mesothelioma) through the bloodstream to other organs.
The TNM System looks at three components:  the tumor (T), the lymph nodes (N), and the spreading of the disease, otherwise known as metastasis (M).  It is also divided into four stages.
  • Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium (the fluid filled sac that surrounds the heart), or diaphragm on the same side. Lymph nodes are not involved.
  • Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
  • Stage III: Mesothelioma has now invaded the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side. It may or may not have spread to lymph nodes on the same side as the primary tumor.
  • Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastasis is included in this stage.
The most recent system to be devised is the Brigham System.  It stages the disease according to the ability to surgically remove the tumor (resectability) and the involvement of the lymph nodes.  It, too, is divided into four stages.
  • Stage I: Mesothelioma is resectable and no lymph node involvement.
  • Stage II: Mesothelioma is resectable but with lymph node involvement.
  • Stage III: Presence of unresectable Mesothelioma extending into the chest wall, heart, or through the diaphragm or peritoneum; with or without extra-thoracic lymph node involvement.
  • Stage IV: Distant metastatic disease (widespread cancer throughout the body).
Diagnosis is achieved in a number of ways, especially because other diseases may possess similar symptoms to those presented by Mesothelioma.  A wide variety of imaging techniques may be used in diagnosis, such as CT scans, MRI, and conventional x-rays.  Some doctors also choose to test the pleural fluid for malignant cells.

Biopsy, however, is by far the most accurate way to diagnose Mesothelioma.  Needle biopsies, done under local anesthetic, may be used but provide only small tissue samples.  That means the accuracy rate might be less than desirable.  The preferred course of action in suspected Mesothelioma is an “open” biopsy, which provides a larger tissue sample.  This type of biopsy is performed in a hospital setting under general anesthesia.

Do you suspect that you or someone close to you may be suffering from Mesothelioma or do you worry about a spouse or loved ones’ previous exposure to asbestos?  Learn the facts about asbestos and the diseases it causes by ordering our free Mesothelioma Resource Kit. 

What is Asbestosis?

Sometimes referred to as "diffuse pulmonary fibrosis," asbestosis is a lung condition that results from the inhalation of asbestos fibers. Most often associated with those who work directly with asbestos or asbestos-containing products, asbestosis can lead to more dangerous forms of asbestos disease - such as mesothelioma - later in life.

How Asbestosis Develops

It isn't easy for foreign matter to enter the lungs. As a matter of fact, the nose and the bronchi act as filters and are able to stop most particles before they even gets close to one's lungs. But because asbestos fibers are thin, needle-like, and microscopic, they are able to penetrate the filters and make their way into the lungs, where they usually lodge in the lining of the lung, known as the pleura.

The presence of asbestos in the lungs eventually causes scarring or "fibrosis," which may later result in the formation of tumors and the development of cancer.

Symptoms of Asbestosis

The symptoms of asbestosis do not appear quickly. It can take as long as 10 to 40 years to begin to recognize symptoms that indicate a problem with the lungs. The most common symptoms of this occupational disease are:

  • Shortness of breath (dyspnea) - This is often the first symptom to appear and, as mentioned before, it may be ten or more years before shortness of breath is evident. In the early stages of the disease, the shortness of breath will occur only after extreme exertion, but as the asbestosis progresses, the dyspnea will occur on a more regular basis.
  • Persistent, dry cough - This troublesome cough, which often makes it difficult to sleep and eat, may be accompanied by chest pain. The victim may also find blood in the sputum.
  • Chest tightness - Many victims of asbestosis believe they have heart disease or are having a heart attack because the pain can be similar. The pain or tightness is caused by scar tissue that does not expand properly or with ease during the breathing process.
  • Loss of appetite - This is often a result of the combination of the other annoying symptoms of the disease. Some victims also report difficulty swallowing, which makes eating uncomfortable.
  • Clubbing of fingers (advanced stages) - This increased curvature of the nails and thickening of the digits is often indicative of a serious pulmonary disorder such as asbestosis.

Diagnosing Asbestosis

If you're experiencing symptoms consistent with asbestosis, you'll probably decide to visit your general practitioner. That's a good first step. It is essential, however, that the doctor be familiarized with the occupational background of those who worked with asbestos so that he/she can more readily make the correct diagnosis.

After discussing work and medical history, your doctor will probably order a chest x-ray, which may show scarring or calcifications. The results of the chest x-ray may determine the need for the use of a more sophisticated form of imaging, such as a CT scan or MRI. These can provide a more complete and clearer picture of the lung area and any scarring or tumors that may be present.

By far, however, the most accurate way to make a diagnosis of asbestosis is by means of an open lung biopsy. This procedure involves surgery under general anesthesia. During the surgery, a sample of lung tissue will be taken and sent to a pathologist for analysis. Results will be available at a later date. Most doctors maintain that this is the best way to determine whether patients have asbestosis or the more serious asbestos-related disease, mesothelioma, which is a cancer of the lining of the lungs.

There is no cure for asbestosis but there are ways to alleviate the uncomfortable affects of the disease. Humidifiers may help relieve the dry coughing and doctors may recommend additional respiratory treatments to ease breathing difficulties.

However, if you are a smoker and have been diagnosed with asbestosis, it is essential to STOP SMOKING NOW! The combination of smoking and asbestosis is a lethal one and smokers with asbestosis have a 55% higher chance of developing mesothelioma than non-smokers.

Who Gets Asbestosis?

Anyone who has had ongoing direct or secondary exposure to asbestos or asbestos-containing products can develop asbestosis. Not everyone who is exposed to asbestos will develop the disease, but everyone who develops the disease has indeed been exposed to asbestos.

Those at highest risk work or have worked at jobs where they encountered asbestos on a regular basis. Those occupations include shipyard workers, railroad employees, power plant employers, steel mill workers, oil refinery workers, contractors/construction workers, firefighters, and those employed at vermiculite or talc mines or in factories that produce asbestos-containing products.

Family members of someone who has had daily contact with asbestos have also been known to develop asbestosis, caused by exposure to asbestos particles brought home on the clothes of that person.

Asbestosis can also occur among individuals who live in communities near an asbestos mine or in the vicinity of a factory that manufactures asbestos or asbestos-containing products. Such secondary exposure is being reported more and more often and is a genuine concern. Be sure to tell your doctor if you lived near an asbestos factory or mine.