'STAGES OF MESOTHELIOMA'

MESOTHELIOMA STAGES
Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

Staging is the term used to describe the extent of a patient’s cancer, based on the primary tumor and its spread in the body. It can help the medical team plan treatment, estimate prognosis and identify clinical trials for which the patient may be eligible.

Staging is based on a knowledge of how the cancer develops, from the primary tumor, to the invasion of nearby organs and tissues, to distant spread or metastasis. Staging systems have evolved over time, and they continue to change as scientists learn more about cancer. Some staging systems cover many different types of cancer, while others focus on more specific cancers. The TNM (primary tumor, regional lymph nodes, distant metastasis) is the most common staging system for mesothelioma.

Some elements common to most staging systems are:

Location of the primary tumor.
Size and number of the tumors.
Lymph node involvement.
Cell type and tumor grade.
Metastasis.
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.
Regional – cancer that has spread from the primary site to nearby lymph nodes or organs.
Distant – cancer that has spread from the primary site to distant lymph nodes or organs.
Unknown – cases where not enough information exists to indicate stage.
Several types of testing may be used to help doctors determine stage, and to formulate a treatment plan.

Physical examinations. The doctor examines the body by looking, feeling and listening to anything out of the ordinary.
Imaging techniques. Procedures such as x-rays, CT scans, MRIs and PET scans may show the location, size of the tumor and whether the cancer has spread.
Laboratory tests. Studies of blood, urine, fluid and tissue can provide information about the cancer. Tumor markers, sometime elevated when cancer is present, may provide information.
Pathology reports. Results of the examination of tissue samples can include information about the size of the tumor(s), extension into adjacent structures, type of cells and grade of the tumor. Results of the examination of cells in fluid, such as that from a mesothelioma-related pleural effusion, may also provide information.
Surgical reports. Observations about the size and appearance of the tumor(s), lymph nodes and nearby organs.
Staging information should be provided to the patient by his doctor so that potential treatment plans can be discussed. Stage of the mesothelioma, as well as consideration of other factors such as age, health status and the patient’s wishes may dictate different treatment options.

The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System – extent of primary tumor mass

Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.
TNM System — variables of T (tumor), N (lymph nodes), M (metastasis)

Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.
Brigham System: (variables of tumor resectability and nodal status)

Stage I: Resectable mesothelioma and no lymph node involvement
Stage II: Resectable mesothelioma but with lymph node involvement
Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
Stage IV: Distant metastatic disease

'MESOTHELIOMA CAUSES'

CAUSES
Mesothelioma Causes

Mesothelioma - a cancer that typically attacks the lungs and abdomen - was profoundly rare until the industrial and commercial use of asbestos expanded in the 20th century. Medical researchers have spent decades investigating the disease and what causes it, and their findings are that asbestos exposure is the primary culprit.

Through studies aimed at pinpointing the exact causes of mesothelioma, researchers gradually learned how being exposed to asbestos triggers cancer.

In March 2009, the International Agency for Research on Cancer reconfirmed that all forms of asbestos can cause mesothelioma - and asbestos exposure is the foremost cause of mesothelioma.

Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Usually, this involves men over 40 years of age. Others have been exposed to asbestos in a household environment, often without knowing it. Interestingly, the number of new cases of mesothelioma has been relatively stable since 1983, the same time that the restrictions on asbestos were instituted by the U.S. Occupational Safety and Health Administration (OSHA). In Europe, the number of new cases of mesothelioma continues to rise.

DIAGNOSING ...

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, withparacentesis or ascitic drain; and for pericardial^{[disambiguation needed]} effusion withpericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.

Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

"SYMPTOMS OF MESOTHELIOMA "

"SYMPTOMS OF MESOTHELIOMA"

Symptoms of mesothelioma cancer include the following:

Pleural mesothelioma cancer:

• Pain in the lower back or at the side of the chest
• Shortness of breath
• Trouble swallowing
• Hoarseness
• Persistent cough
• Persistent fever
• Excessive sweating
• Fatigue
• Unexplained weight loss

Peritoneal mesothelioma cancer:

• Stomach pain
• Unexplained weight loss
• Nausea
• Vomiting
• Swelling of the abdomen

It's important to remember that these symptoms may be caused by other, less serious conditions. In addition, other cancers can exhibit the same symptoms as pleural mesothelioma cancer, such as small cell lung cancer or non-small cell lung cancer. If you experience the symptoms of mesothelioma cancer, please visit your physician for an accurate diagnosis.

Your doctor may employ a number of resources to accurately diagnose mesothelioma cancer, beginning with a discussion of your medical history, followed by a complete physical examination including X-rays of the chest and lung function tests. Further tests may include a CT scan, an MRI, a bronchoscopy (a procedure in which a tiny camera at the end of a flexible tube is inserted into the chest via the mouth), and finally, for complete confirmation, a biopsy. These methods will also be used to stage, or determine the progression of, the disease.

WHAT IS MESOTHELIOMA

"MESOTHELIOMA"

Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, themesothelium. It is usually caused by exposure to asbestos.^[1]

Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart),^[2] or the tunica vaginalis (a sac that surrounds the testis).

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.^[3] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers.^[4] Those who have been exposed to asbestos have collected damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in law practices regarding mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with abiopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapyor sometimes surgery, the disease carries a poor prognosis. Research about screening testsfor the early detection of mesothelioma is ongoing.