Whenever you become ill, it is normal for your doctor to assess your condition and determine how bad your illness is. The same principle applies to a cancer diagnosis. Individuals with pleural mesothelioma, the most common form of mesothelioma, will be diagnosed according to the stage of cancer they have. Doctors use one of three different staging systems to determine how far the cancer has progressed and what treatment options might work best.
The stages of mesothelioma, and other cancers for that matter, correlate to the seriousness of the disease. Earlier stages are often more treatable, while stages 3 and 4 are considered more severe and damaging. The stages are measured based on the spread of the disease, the size of the tumors, and several other factors.
The TNM Staging System
According to the American Cancer Society, the TNM system, which was created by the American Joint Committee on Cancer, is the most widely accepted staging system. This system determines stages based on the size of the main tumor, the spread of cancer to nearby lymph nodes, and the spread of cancer to other organs in the body.
Stage 1
A patient will be considered stage 1 if the tumor is localized in the pleura lining in the chest wall on only one side. It might also affect the pleura lining of the diaphragm, the space between the lungs, or the pleura covering the lung. However, at this stage it has not spread elsewhere in the body, nor is it in the lymph nodes. It might also be considered stage 1B if it has spread to nearby structures, but those tumors are still easily removable. It could also have spread into other layers of the chest or lung.
Stage 2
At stage 2, the cancer has grown in the pleura lining of the chest on one side, as well as the diaphragm or the lung. It has also spread to local lymph nodes but still has not spread to other organs.
Stage 3
Stage 3 mesothelioma is in the pleura lining in the chest on one side, as well as the pleura of the lung, diaphragm, and the area between the lungs. It will also have moved into the first layer of the chest wall, the fatty tissue between the lungs, the deeper layers of the chest wall, or the surface of the heart. The cancer will also have spread to the local lymph nodes. It might have also grown into nearby organs or structures, but it could still be removable through surgery. At this stage, the main tumor might also have grown too far to be completely removed through surgery.
Stage 4
The main mesothelioma tumor has spread to nearby structures, lymph nodes, and distant organs. This may include growth in the bones, liver, lung, or the lining of the abdomen.
The Butchart Staging System
The Butchart staging system is the oldest system for diagnosing mesothelioma, and is still widely used and trusted today. Doctors using this system will stage the cancer based on the size of the tumor.
Stage 1
At stage 1, the cancer is only present in one side of the chest lining, though it might also have spread to the pericardium or the diaphragm.
Stage 2
The cancerous tumors are in the chest lining and may have spread to both sides. The esophagus or the lining of the heart could also have cancerous growths, and the nearby lymph nodes might also be affected.
Stage 3
Stage 3 mesothelioma tumors have spread to either the diaphragm or the abdominal lining. The lymph nodes outside of the chest cavity will also have been affected by mesothelioma cells.
Stage 4
Not only is a cancerous tumor in the chest, it has also spread to other organs or body parts, has affected the bloodstream, and the lymph nodes.
The Brigham Staging System
Although the TNM system does take surgical options into account, the Brigham staging system gauges the stage of cancer solely on a doctor’s ability to potentially remove the cancer surgically.
Stage 1
At stage 1, the mesothelioma tumor has not yet spread elsewhere and has not been found in the lymph nodes. Doctors will be able to remove the cancer in its entirety via surgery.
Stage 2
Though the cancer will be confined mostly to a tumor in the lining of the lungs, it will also have spread to the lymph nodes near the affected area. At stage 2, it is still possible to remove the cancer through surgery.
Stage 3
At stage 3, surgery is no longer an option, as cancer has spread to nearby organs and structures, like the chest wall or diaphragm.
Stage 4
Surgery is also out of the question for stage 4 patients. At this point, the cancer has spread to organs in other parts of the body, as well as the lymph nodes.
Unfortunately, because mesothelioma is so rare, the only variation of the disease currently followed by a staging system is pleural mesothelioma. However, doctors can still assess and treat all forms of mesothelioma cancers depending on the condition of each individual patient.
If you were diagnosed with mesothelioma, you might have contracted the disease from asbestos exposure. Asbestos exposure is the most common cause of mesothelioma and is often related to dangerous work environments, toxic debris, and old home insulation or piping. If you notice any symptoms of disease see your doctor immediately and find out if you have mesothelioma, and what treatment options are available to you.
Mental Health and Mesothelioma: Stages of Grief
The damaging effects of asbestos exposure don’t only impinge on a person’s physical health. Victims of asbestos-related illnesses suffer psychologically, as well. In this exclusive ongoing series, we’ll shed some light on that other side of terminal illness by examining the impact of mesothelioma and other asbestos-related diseases on mental and emotional health-not just for patients but for their loved ones as well.
Some of the topics we’ll cover include: psychiatric conditions common to victims of mesothelioma cancer and other related conditions, how to share news of a terminal diagnosis with loved ones, coping with grief and loss, types and stages of the bereavement process, self-help techniques for managing mental health during treatment and more.
Mesothelioma and Mental Health-PART THREE
For those affected by mesothelioma, stages of grief are an almost universal experience-although they tend to manifest in different forms and occur on individualized timelines. While today’s researchers often point out that the grieving process can be considerably more multifaceted than any single model can wholly represent, there are specific paradigms that are commonly utilized in grief counseling and palliative care settings as a therapeutic basis.
The Kübler-Ross Model and Modern Interpretations
Most well known in contemporary psychotherapy and medical settings is the Kübler-Rossmodel, which outlines five stages of grief that are typically faced by both those anticipating death (i.e. malignant mesothelioma victims themselves) and those anticipating loss (i.e. family and loved ones of victims).
For anyone facing a terminal cancer like mesothelioma, the stages of grief are considered a virtually collective experience. However, it is important to note that most recent research into grief has revealed the process as being largely non-linear-meaning that although earlier models (like the five stages) may have outlined grief in successive stages, the reality of the experience is much less structured and far more varied in nature.
Some individuals seem to go through the stages of grief in cycles, revisiting previously experienced stages throughout the process. Others may not experience all of the stages at all, or may experience them in an entirely different order than that designated by the five stages model.
The Five Stages
Following are five-commonly experienced by victims of mesothelioma-stages of grief, as defined within the well-known Kübler-Rossmodel. Together, they form the acronym DABDA-frequently used in medical and therapeutic settings such as mesothelioma cancer support groups and hospice care facilities.
- Denial-the rejection or suppression of a painful reality (common concurring reactions include shock and isolation)
- Anger-characterized by irrational blame or rage, often directed at one or more targets (such as a diagnosing physician or a higher power); typical reactions include “why me?” and “it isn’t fair”
- Bargaining-defined as displaced hope, an attempt to avoid the anticipated event/loss by making negotiations or deals with one’s higher power (perhaps offering, in exchange for survival and regained health, a reformative lifestyle or major personal sacrifice)
- Depression-typically accompanied by a movement towards acceptance of the finality of one’s situation, often characterized by feelings of surrender, hopelessness, worry and fear
- Acceptance-signifies the commencement of the coping process and one’s ability to “come to terms” with a tragic reality, typically characterized by feelings of calmness or even serenity and may accompany some type of “spiritual awakening” or moral realization; reaching this stage takes time (not always attainable such as in cases of sudden or unexpected death loss)
Mesothelioma Progression: How the Disease Differs Across Different Types
Mesothelioma, a rare and aggressive form of cancer, is primarily caused by exposure to asbestos. While this disease shares a common origin, its progression varies significantly depending on the type of mesothelioma diagnosed. This blog will explore how mesothelioma progression differs across different types and its implications for patients and their treatment.
1. Pleural Mesothelioma: Progression in the Lungs
Pleural mesothelioma is the most common type, accounting for approximately 75% of all cases. It originates in the lungs and chest cavity lining, known as the pleura. Mesothelioma progression in the pleura typically begins with the development of small tumor nodules. Over time, these nodules grow and expand, encasing the lungs and causing symptoms such as chest pain, coughing, and difficulty breathing. As the disease advances, it may spread to nearby tissues, including the chest wall, diaphragm, and heart lining.
2. Peritoneal Mesothelioma: Progression in the Abdomen
Peritoneal mesothelioma affects the lining of the abdomen, known as the peritoneum. Mesothelioma progression in the peritoneum usually starts with the formation of tumor nodules on the abdominal lining. These nodules can cause abdominal pain, swelling, and digestive issues. Unlike pleural mesothelioma, peritoneal mesothelioma tends to remain localized in the abdominal cavity for an extended period before spreading to distant organs. This difference in progression can impact treatment options and prognosis.
3. Pericardial Mesothelioma: Progression Around the Heart
Pericardial mesothelioma, known as the pericardium, is the rarest type, affecting the lining around the heart. Mesothelioma progression in the pericardium can be particularly challenging due to the proximity to vital organs. Initially, patients may experience chest pain and heart palpitations. As the disease advances, it can lead to fluid buildup around the heart (pericardial effusion) and interfere with heart function. Because of its rarity and sensitive location, pericardial mesothelioma often presents unique diagnostic and treatment challenges.
4. Mesothelioma Progression & Legal Help
Mesothelioma progression can differ significantly depending on the type diagnosed. Understanding these differences is essential for both patients and healthcare providers, as it can impact treatment decisions, prognosis, and overall disease management. Regardless of the type, early diagnosis and specialized care by mesothelioma experts are crucial to improving the quality of life and outcomes for individuals battling this challenging disease. Those who have been diagnosed with mesothelioma may be entitled to legal compensation, which can help rising medical bill costs for those affected. The mesothelioma trial lawyers at Shrader & Associates can provide legal support if you or someone you know has been diagnosed with mesothelioma. Contact a member of their team for a free consultation.
Mesothelioma – Stages of the Disease
This month we will cover two sides of mesothelioma: the legal attributes and the medical attributes. Each side of this disease can be heavily daunting. One side of the coin gives you a diagnosis that in a large majority of the cases is fatal within 2 years. There are many obstacles to cover to prolong life and protect and preserve the quality of life that remains. The other side of the coin represents the law and the illegal exposure to asbestos that was the cause of your deadly illness. Most will want to legally pursue options to hold the parties of this exposure responsible and go after monetary compensation.
Your first inclination about asbestos-related illness will come from a medical diagnosis. Most people are devastated and do not know exactly where to begin. Finding a medical professional or specialist near you will be your first priority. Your next priority will be understanding the legal implications of the negligence of others afflicting you with a deadly disease and you will want to take legal recourse.
Both sides of this coin represent a battle – each with specific steps and understandings you must comprehend and master in order to win the war. This months’ blogs will help to empower you with information to cover both fronts.
For every patient diagnosed with mesothelioma stages of the disease will be defined by a doctor. The stage of cancer will help determine what course of treatment may best suit you. As you will learn below, depending upon the stage of the cancer, different therapies including radiation, surgery or chemotherapy are recommended to either remedy the cancer or to manage pain for the patient. It is important to find an experienced medical center and staff to make sure you are receiving the best care.
Stage one signifies that the metastasis is limited. Depending upon when the cancer is diagnosed, it could be limited to a specific area of the body. In the case of pleural mesothelioma, it could be limited to the outer pleura which is the lining of the chest wall.
As with other cancers, patients understanding mesothelioma stages will learn that a diagnosis within this stage leads to a more positive mesothelioma prognosis.
Stage two normally involves a localized tumor that has not started to spread to other areas within the body. Cancer cells have started to spread to the organs associated with the type of mesothelioma or to the lymph nodes.
Stage three is when the tumor has spread throughout one side of the body. It has invaded either the lungs, peritoneum in the case of peritoneal mesothelioma or the nearby lymph nodes. Diagnosis in this stage is still better than stage four as the patients’ individual health can help them survive longer.
Stage four is when there has been extensive metastasis other than in the area of the primary tumor. Most likely, cancer cells have invaded sections of most organs. An average survival rate in this stage is 12 months.
Stages of Mesothelioma
Staging is a prognosis tool used to determine how far a case of cancer has spread. It may affect what treatment options are available and/or most likely to be effective for the patient. Pleural mesothelioma, the most common form, may be staged using a few systems. There are currently no formal staging systems for the other forms of mesothelioma.
Pleural Mesothelioma Staging Systems
Doctors currently use three main staging systems to determine how far a patient’s stages of mesothelioma has progressed. Each system uses four stages to describe the progression of a particular case, but the definitions of each stage vary slightly according to the method used.
Butchart Staging System
The Butchart System is the most widely recognized and most commonly used staging system for pleural mesothelioma. This system looks at tumor size and spread to determine stage:
- Stage 1: The mesothelioma has affected the right or left side of the pleural lining and may be seen in the diaphragm.
- Stage 2: Both sides of the lungs show the presence of malignant mesothelioma, as do the lymph nodes. In Stage 2, the disease may also have spread to the heart, stomach, or esophagus.
- Stage 3: In Stage 3, the mesothelioma has reached the peritoneum (lining of the abdominal cavity) as well as lymph nodes past the chest.
- Stage 4: The cancer has entered the bloodstream and spread to additional organs that are not contiguous to the pleura.
TNM Staging System
The TNM System was developed by the American Joint Committee on Cancer. It is similar to the Butchart system and takes cues from staging systems created for other types of cancer. This system weighs not only the condition of tumors but also the effect of mesothelioma on the lymph nodes and whether the cancer has spread (metastasized) to other parts of the body.
TNM stands for tumor (T), node (N), and metastasis (M)—the three factors a doctor must consider when using this staging system. When using the TNM staging system, within the stages of mesothelioma your doctor will ask:
- (Tumor) How large is the primary tumor and what is its location?
- (Node) Has the tumor metastasized to the lymph nodes?
- (Metastasis) Has the tumor metastasized to other organs?
Substages Within the TNM System
The TNM staging system allows doctors to denote a patient’s disease with a high level of specificity. Here are the values doctors use to describe a patient’s diseases by category.
Tumor size and location:
- T0 – No tumor exists
- T1 – The tumor has penetrated the ipsilateral (one side of the) pleura.
- T2 – Either of the ipsilateral pleural membranes is involved and the tumor has also penetrated either the diaphragm or the lung.
- T3 – In addition to pleural membrane involvement, one of the following conditions also exists: Invasion of the membrane that surrounds the thorax; invasion into the area of the chest between the lungs; one area of invasion into the chest wall muscles; or slight invasion into the lining around the heart.
- T4 – The tumor has invaded more than one area of the chest wall; the abdominal cavity; other organs in the chest; the spine; and/or the pericardium (the membrane surrounding the heart) OR the mesothelioma is affecting both pleura.
- TX – This designation means that the doctor was unable to evaluate the tumor.
Lymph node metastasis:
- N0 – The cancer has not spread to the lymph nodes in the area around the tumor.
- N1 – The cancer has spread to the lymph nodes either inside or outside of the pleura.
- N2 – It has spread to the lymph nodes in the area between the lungs on both sides of the body, the lymph nodes near the breast bone, and/or the lymph nodes above the collar bone on one or both sides of the body
- NX – this designation means the doctor was unable to evaluate the lymph nodes around the tumor.
Spread to other organs:
- M0 – The cancer has not metastasized to other organs.
- M1 – The cancer has spread to other organs.
Determining the Stages of Mesothelioma Cancer in the TNM System
Once the doctor has finished the TNM assessment, the information from the various subgroups is then combined to assign the stages of mesothelioma – stage of the cancer. Your doctor may choose to use letters to further differentiate (stages 1A/1B, for example).
- Stage 1: The malignant mesothelioma is in either the right or the left pleura. It may have also spread to one lung, the heart, or the diaphragm on the same side.
- Stage 2: The cancer has reached a lymph node on the same side of the body as the affected lung. It has also spread to the lung on the same side as the tumor, or to the heart or diaphragm.
- Stage 3: The mesothelioma has entered the abdominal cavity and lymph nodes beyond the chest.
- Stage 4: The mesothelioma has spread throughout the pleural area as well as to the lymph nodes on both sides of the body. The cancer may also have reached additional organs or the abdomen at this stage.
Brigham Staging System
The Brigham System is the most modern mesothelioma staging system. Unlike the Butchart and the TNM Systems, the Brigham system also assesses the anticipated effectiveness of surgical intervention at each stage.
- Stage 1: The mesothelioma tumor is still removable and lymph nodes are unaffected by the cancer.
- Stage 2: Lymph nodes are affected but the cancer can still be removed surgically.
- Stage 3: When the mesothelioma has reached the heart, chest cavity, abdominal cavity, or the diaphragm, surgical intervention is no longer a viable treatment option.
- Stage 4: The mesothelioma has metastasized throughout the body and could not be removed by surgery.
Determining the Stages of Mesothelioma and a Prognosis
When malignant/cancer cells are shown on a CT Scan or MRI in the layer of tissue lining the chest cavity that covers the lungs, your doctor will give you a mesothelioma prognosis. The news will not be good and time will become a very important factor to you. The mesothelioma prognosis will detail that you will probably only survive for up to two years. The treatments you select to prolong your prognosis will actually determine not only how long you have left to live but the quality of life you will experience.
Once you have come to terms with the stages of mesothelioma and your mesothelioma prognosis, you might want to find out about how you contracted the disease. The normal culprit is asbestos exposure. This could have occurred upwards of 30 years or more in the past and normally happened at a workplace. The percentages are high if you worked in an industry – say construction or perhaps in the Navy – that had high levels of exposure before strict regulations were put into place by the EPA in 1980.
Working in proximity to asbestos means you could have inhaled or swallowed the microscopic fibers. The time between exposure and actual mesothelioma diagnosis is usually decades because the stages of mesothelioma so closely resemble those of common winter ailments.
Many people with mesothelioma were employed or had homes in places where they could have swallowed and breathed in asbestos. After the exposure, it normally takes a long period of time for a mesothelioma malignancy to form. Other risk factors for malignant mesothelioma include having daily and close contact with someone who worked near asbestos or even washing the clothes of someone who worked heavily with asbestos. If the microscopic fibers adhered to their clothing, if handled by someone, they could again become airborne and enter the body the same way.
Treatment of Mesothelioma by Stage
Unfortunately, mesothelioma is rare enough and its symptoms so nonspecific it is not usually diagnosed until a patient has already reached the later stages of mesothelioma. Anyone who is aware of asbestos exposure in their past should let their doctor know for this reason. By closely monitoring lung health, they may be able to catch tumor growth before it spreads throughout the body.
The earlier a case of mesothelioma can be detected, the much better a patient’s prognosis.
Millions Recovered for Mesothelioma Victims & Their Families
The effects of mesothelioma can be devastating. For years, Shrader & Associates L.L.P. has aggressively fought on behalf of individuals who were seriously harmed by exposure to asbestos.
The complications unique to your circumstances don’t intimidate us. Our mesothelioma attorneys provide meticulous case investigation, thorough case preparation, and aggressive representation to each and every client. Over the years, we have won hundreds of cases and reached many verdicts and settlements that benefit our clients and ensure they are taken care of.
Mesothelioma Stage 1
When doctors stage mesothelioma, they use one of two staging systems.
The Butchart System
The oldest, known as the Butchart System, was developed in 1976 by Dr. Eric Butchart, a British cardiothoracic surgeon. Some oncologists and thoracic surgeons still use this system because they believe it to be the most accurate way to measure the progression of the disease. A description of Dr. Butchart’s classification system appears in the article he authored titled “Contemporary Management of Malignant Pleural Mesothelioma”, published December 1999 in The Oncologist.
The TNM System
The other system, known as the TNM System, is currently the most widely used. It was originally developed by French physician Pierre Denoix from 1943 to 1952. In 1990, The International Union Against Cancer (UICC) developed a version of the TNM system to be used for lung cancer staging based on the TNM methodology used for other tumors. In 1995, this system was adapted by the International Mesothelioma Interest Group (IMIG) to give precise descriptions of tumor involvement in various areas of the body.
The IMIG staging system was adopted by the American Joint Committee on Cancer (AJCC) and the UICC in 2002 so that there would be uniformity. Today, the version of the TNM classification that is in practice follows the rules of classification and staging that appear in The Seventh Edition AJCC Cancer Staging Manual, which was released in 2009 with revisions implemented in January, 2010.
Stage I – The Butchart System
The tumor has not gone beyond the parietal pleura, which is the part of the pleura that connects to the chest wall. Also, it has not spread to regional lymph nodes. The tumor is considered to be operable; and survival rates are good for patients at this stage that have negative surgical margins and no lymph node involvement.
A surgical margin refers to an evaluation of a tumor that has been removed to see if normal tissue has been removed with it. If there is normal tissue that means the entire visible tumor has been removed. Keep in mind that microscopic cells may have been left behind, resulting in the need for chemotherapy/radiation. However, it is highly likely that these additional therapies will remove all of the remaining cancer cells.
Stage I – The TNM System
The TNM system is based on the evaluation of three components:
- T- The extent of the primary tumor
- N- Whether or not the tumor has spread (metastasized) into the regional lymph nodes and how extensively it has spread
- M – Whether or not there is distant metastasis
Numbers are used in conjunction with each letter to indicate the extent of the disease. In stage I, the tumor is small and remains local. It has not metastasized to any lymph nodes or any other parts of the body.
Stage 1 is subcategorized into 1A and 1B:
- Stage 1A – the tumor size is up to 3cm
- Stage 1B – the tumor size is between 3 to 5cm
The tumor is considered operable and the prognosis is good with the addition of chemotherapy/radiation.