Malignant Pleural Mesothelioma Staging
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The TNM classification for malignant pleural mesothelioma staging is provided below. [1, 2]
Table. TNM Classification for Malignant Pleural Mesothelioma (Open Table in a new window)
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
T1
Tumor limited to the ipsilateral parietal pleura with or without mediastinal pleura and with or without diaphragmatic pleural involvement
T1a
No involvement of the visceral pleura
T1b
Tumor also involving the visceral pleura
T2
Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Involvement of the diaphragmatic muscle
Extension of tumor from the visceral pleura into the underlying pulmonary parenchyma
T3
Locally advanced but potentially resectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Involvement of the endothoracic fascia
Extension into the mediastinal fat
Solitary, completely resectable focus of tumor extending into the soft tissue of the chest wall
Nontransmural involvement of the pericardium
T4
Locally advanced, technically unresectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction
Direct diaphragmatic extension of the tumor to the peritoneum
Direct extension of the tumor to the contralateral pleura
Direct extension of the tumor to a mediastinal organ
Direct extension of the 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
Regional lymph nodes (N)
NX
Regional lymph node(s) cannot be assessed
N0
No regional lymph node metastases
N1
Metastases in the ipsilateral bronchopulmonary or hilar lymph node
N2
Metastases in the subcarinal or in the ipsilateral mediastinal lymph node, including the ipsilateral internal mammary and peridiaphragmatic nodes
N3
Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes
Distant metastases (M)
M0
No distant metastasis
M1
Distant metastasis
Table. Anatomic stage/prognostic groups (Open Table in a new window)
Stage
T
N
M
I
T1
N0
M0
IA
T1a
N0
M0
IB
T1b
N0
M0
II
T2
N0
M0
III
T1, T2
N1
M0
T1, T2
N2
M0
T3
N0-2
M0
IV
T4
Any N
M0
Any T
N3
M0
Any T
Any N
M1
Stage I:
Completely resected within the capsule of the parietal pleura without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites)
Stage II:
All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination
Stage III:
Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes
Stage IV:
Distant metastatic disease
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. Pleural mesothelioma. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer-Verlag; 2010. chap 26.
NCCN Clinical Practice Guidelines in Oncology. Melanoma. V2.2011. Available at http://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf. Accessed: March 28, 2011.
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
T1
Tumor limited to the ipsilateral parietal pleura with or without mediastinal pleura and with or without diaphragmatic pleural involvement
T1a
No involvement of the visceral pleura
T1b
Tumor also involving the visceral pleura
T2
Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Involvement of the diaphragmatic muscle
Extension of tumor from the visceral pleura into the underlying pulmonary parenchyma
T3
Locally advanced but potentially resectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Involvement of the endothoracic fascia
Extension into the mediastinal fat
Solitary, completely resectable focus of tumor extending into the soft tissue of the chest wall
Nontransmural involvement of the pericardium
T4
Locally advanced, technically unresectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:
Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction
Direct diaphragmatic extension of the tumor to the peritoneum
Direct extension of the tumor to the contralateral pleura
Direct extension of the tumor to a mediastinal organ
Direct extension of the 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
Regional lymph nodes (N)
NX
Regional lymph node(s) cannot be assessed
N0
No regional lymph node metastases
N1
Metastases in the ipsilateral bronchopulmonary or hilar lymph node
N2
Metastases in the subcarinal or in the ipsilateral mediastinal lymph node, including the ipsilateral internal mammary and peridiaphragmatic nodes
N3
Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes
Distant metastases (M)
M0
No distant metastasis
M1
Distant metastasis
Stage
T
N
M
I
T1
N0
M0
IA
T1a
N0
M0
IB
T1b
N0
M0
II
T2
N0
M0
III
T1, T2
N1
M0
T1, T2
N2
M0
T3
N0-2
M0
IV
T4
Any N
M0
Any T
N3
M0
Any T
Any N
M1
Winston W Tan, MD, FACP Associate Professor of Medicine, Mayo Medical School; Consultant and Person-in-Charge of Genitourinary Oncology-Medical Oncology, Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic Jacksonville; Vice Chairman of Education, Division of Hematology/Oncology, Mayo Clinic Florida
Winston W Tan, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, Texas Medical Association
Disclosure: Nothing to disclose.
Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee
Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology
Disclosure: Nothing to disclose.
Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center
Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology
Disclosure: Nothing to disclose.
Malignant Pleural Mesothelioma Staging
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