Malignant Pleural Mesothelioma Staging 

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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 

Research & References of Malignant Pleural Mesothelioma Staging |A&C Accounting And Tax Services
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Malignant Pleural Mesothelioma Staging 

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