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Malignant Mesothelioma Treatment (PDQ®)

Health Professional Version
Last Modified: 03/07/2014

Stage Information for Malignant Mesothelioma

Definitions of TNM

Patients with stage I disease have a significantly better prognosis than those with more advanced stages. Because of the relative rarity of this disease, exact survival information based upon stage is limited.[1]

Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define malignant mesothelioma.[2]

International Mesothelioma Interest Group Staging System for Diffuse Malignant Pleural Mesothelioma

Table 1. Primary Tumor (T)a
aReprinted with permission from AJCC: Pleural mesothelioma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 271-7.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
T1Tumor limited to the ipsilateral parietal pleura with or without mediastinal pleura and with or without diaphragmatic pleural involvement.
T1aNo involvement of the visceral pleura.
T1bTumor also involving the visceral pleura.
T2Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following: involvement of diaphragmatic muscle; extension of tumor from visceral pleura into the underlying pulmonary parenchyma.
T3Locally advanced but potentially resectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following: involvement of the endothoracic fascia; extension into the mediastinal fat; solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall; nontransmural involvement of the pericardium.
T4Locally advanced technically unresectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following: diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction; direct transdiaphragmatic extension of tumor to the peritoneum; direct extension of tumor to the contralateral pleura; direct extension of tumor to mediastinal organs; direct extension of tumor into the spine; tumor extending through to the internal surface of the pericardium with or without a pericardial effusion or tumor involving the myocardium.

Table 2. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Pleural mesothelioma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 271-7.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastases.
N1Metastases in the ipsilateral bronchopulmonary or hilar lymph nodes.
N2Metastases in the subcarinal or the ipsilateral mediastinal lymph nodes including the ipsilateral internal mammary and peridiaphragmatic nodes.
N3Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes.

Table 3. Distant Metastasis (M)a
aReprinted with permission from AJCC: Pleural mesothelioma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 271-7.
M0No distant metastasis.
M1Distant metastasis present.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage  T N M 
aReprinted with permission from AJCC: Pleural mesothelioma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 271-7.
IT1N0M0
IAT1aN0M0
IBT1bN0M0
IIT2N0M0
IIIT1, T2N1M0
T1, T2N2M0
T3N0, N1, N2M0
IVT4Any NM0
Any TN3M0
Any TAny NM1

References
  1. Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312. 

  2. Pleural mesothelioma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 271-7.