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Stages of Mesothelioma

There is no cure for mesothelioma but long-term survivors prove there are no boundaries for hope. Using a combination of traditional medicine, alternative treatments and groundbreaking clinical trials, many patients have proven living with the disease, and a possible cure, is a reality.

Mesothelioma, like other forms of cancer, is categorized and classified by severity and extent of the disease process, called staging. The stages range from stage I, which is the least severe and often most responsible to curative treatments, to stage IV, which is the most severe and open mostly to palliative care treatments.

Mesothelioma specialists determine the stage of the disease after reviewing medical tests, such as CT scans, biopsies and MRIs. Once a stage is determined, medical teams are able to establish a treatment regimen. However, most cases of mesothelioma are not diagnosed until stages III or IV, which can limit a patient’s treatment options.

General Stages of Mesothelioma

  • Stage I -As the earliest stage of cancer, the tumors are confined to one area of the body and have not metastasized (spread). In general, stage I cancer is the most treatable form of the disease. In stage I, doctors typically suggest aggressive disease treatments including surgery, chemotherapy, radiation and immunotherapy. Since mesothelioma lingers undetected in the body for decades, the disease is not usually diagnosed in stage I.
  • Stage II – At stage II, the tumors are bigger and more abundant. While the disease is still localized, it may have spread to some lymph nodes or nearby organs, such as the diaphragm or the lungs. Typically, aggressive treatments, such as surgery, radiation therapy and chemotherapy, are still an option for stage II patients.
  • Stage III – By stage III, mesothelioma has spread to several organs and tissue near areas where the disease originally formed. Side effects, such as difficulty breathing, stomach pains and chest pains, can occur. In some cases of stage III mesothelioma, specialists will recommend surgery as a treatment or palliative option, but not a curative option. Advanced stage IV patients may only be offered palliative treatments to ease pain. In selected cases, stage III mesothelioma patients are eligible to take part in clinical studies that have proven effective for some patients.
  • Stage IV – At stage IV, the cancer has spread (metastasized) throughout the body, in the bones and through the bloodstream. Patients can experience pain as a result of large tumors, build up of fluids and difficulty breathing and swallowing. At stage IV, the cancer has spread beyond any curative measures. Instead, doctors offer palliative treatments to reduce pain and discomfort and may recommend clinical treatments and alternative therapies.

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Mesothelioma Staging Systems

Overall, doctors use one of three staging systems for pleural mesothelioma: TNM, Brigham and Butchart. Since there are no formal staging systems for peritoneal, pericardial and testicular mesothelioma, they also follow one of the three staging systems:


The American Joint Committee on Cancer (AJCC) established the TNM staging system to describe the three primary components to a cancer diagnosis – tumor size, lymph node involvement and metastasis. TNM is the most widely used staging system for all cancers and the primary staging system used for pleural mesothelioma.

For TNM, each letter is paired with a number to describe the spread of the disease, as follows:

  • T – Describes tumor growth, ranging from T0 (main tumor cannot be found) to T4 (extensive tumor growth). TX means the primary tumor cannot be measured.
  • N – Describes the spread of the cancer to lymph nodes, ranging from N0 to N3. NX means cancer in the lymph nodes cannot be measured.
  • M – Describes the metastasis (or spread) of the cancer to other organs, with M0 meaning there is no spread and M1 meaning the disease has spread. MX means metastasis cannot be measured.


Created by famed mesothelioma specialist Dr. David Sugarbaker, the Brigham staging system is used for lung cancer and pleural mesothelioma, with the main focus on surgical treatment options. Early stages of the Brigham system (stages I and II) describe cancerous tumors that can be surgically resected, while stages III and IV represent advanced disease stages that cannot be treated surgically.

Sugarbaker, who was the chief of thoracic surgery at Brigham & Women’s Hospital in Boston when he created the system, pioneered the extrapleural pneumonectomy (EPP) as a curative pleural mesothelioma treatment.


Developed in 1976, the Butchart system is the oldest cancer staging system that was created specifically for pleural mesothelioma to identify patients who are eligible for aggressive treatments.

The Butchart system is limited because it was created based on data from just 29 patients who underwent EPP procedures before modern imaging tests, such as MRIs and CT scans, were widely used.

The Butchart system is primarily limited to addressing the spread of the disease and how it can be impacted by aggressive treatments, as follows:

  • Stage I – Cancer is limited to one area of the chest but may reach to the heart area (pericardium) and the muscle that controls the breathing (diaphragm).
  • Stage II – Cancer spread to chest wall and possibly both sides of the pleura, the esophagus, heart and nearby lymph nodes.
  • Stage III – Cancer is detected in the diaphragm, pericardium and traveling through the lymphatic system to organs and tissues outside of the chest area.
  • Stage IV – Cancer has reached all parts of the body and can be found in areas that include the stomach, liver, brain and bones.

Mesothelioma Staging and Treatment Options

While each staging system has variations that describe the spread of the disease, they are overall similar in specific ways: Early stage mesothelioma patients (stages I and II) have more treatment options than later stage patients (stages III and IV). An earlier-stage diagnosis provides patients with better and more varied possibilities for long-term survival.

Anyone who has been diagnosed with mesothelioma should seek medical attention from a mesothelioma specialist who can determine the most appropriate treatment for the disease stage. Contact us for more information today.

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