The Stages of Malignant Mesothelioma
Many cancer registries, such as the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) use summary staging, a system used for all types of cancer. Summary staging groups cancer into five main categories:
In situ – cancer that is present only in the layer of cells in which it began.
Localized – cancer that is limited to the organ in which it began with no evidence of spread, including:
Invasive tumor (mesothelioma) confined to pleura
Ipsilateral parietal and/or visceral pleura
Mesothelioma WITH nodule(s) beneath visceral pleural surface
Regional – cancer that has spread from the primary site to nearby lymph nodes or organs, which includes:
Regional by direct extension only
Extension to adjacent organs/structure:
Chest wall
Connective tissue
Diaphragm
Endothoracic fascia
Heart muscle
No Lung involvement
Mediastinal organs or tissues
Pericardium
Rib
Mesothelioma nodule(s) which have broken through the visceral pleural surface to lung surface
REGIONAL Lymph Nodes
Aortic [above diaphragm]
Peri/para-aortic
Ascending aorta (phrenic)
Subaortic (aortico-pulmonary window)
Carinal (tracheobronchial) (tracheal bifurcation)
Hilar (bronchopulmonary) (proximal lobar) (pulmonary root)
Intrapulmonary
Interlobar
Lobar
Segmental
Subsegmental
Mediastinal
Anterior
Posterior (tracheoesophageal)
Pericardial
Peri/parabronchial
Peri/paraesophageal
Peri/paratracheal
Azygos (lower peritracheal)
Pre- and retrotracheal
Precarinal
Pulmonary ligament
Subcarinal
Regional lymph node(s)
Distant – cancer that has spread from the primary site to distant lymph nodes or organs.
Distant lymph node(s):
Contralateral/bilateral hilar (bronchopulmonary) (proximal lobar) (pulmonary root)
Contralateral/bilateral mediastinal
Scalene (inferior deep cervical), ipsilateral or contralateral
Supraclavicular (transverse cervical), ipsilateral or contralateral
Other distant lymph node(s)
Extension to:
Cervical (neck) tissues
Contralateral lung
Contralateral pleura
Intra-abdominal organs
Peritoneum
Mesothelioma WITH malignant pleural fluid
Pleural effusion
Further contiguous extension
Metastasis
Unknown – cases where not enough information exists to indicate stage.
Note 1: Code 0 is not applicable for this scheme.
Note 2: Ignore pleural effusion which is negative for tumor.
