Staging and prognosis for pleural mesothelioma

After mesothelioma has been diagnosed, your specialist will order further tests to find out if the disease has spread to other parts of the body and, if so, by how much and how far. This process is called staging. Knowing the stage helps doctors to work out your treatment options. 

Prognosis means the expected outcome of a disease.

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Staging mesothelioma

The main test to stage mesothelioma is a CT scan. You may have had a CT scan earlier when mesothelioma was suspected, or during a CT-guided core biopsy. If this CT scan showed advanced disease, a further CT scan may not be necessary.


Staging systems for mesothelioma

Staging is a way to describe the size of the cancer and whether and how far it has spread beyond its original site. Doctors use particular systems when staging different types of mesothelioma.

TNM staging system for pleural mesothelioma
The staging system recommended for pleural mesothelioma is the international tumour–node–metastasis or TNM staging system.

T (tumour) 1–4 Describes if the pleural mesothelioma has grown in and beyond the pleural cavity. The higher the number, the further it has grown. If limited to the pleura on one side of the chest, it is T1. If it has grown into the lung or beyond, it is T2, T3 or T4.
N (node) 0–3 Describes if the pleural mesothelioma has spread to the lymph nodes. No lymph nodes affected is N0; spread only to lymph nodes on the same side of the chest is N1; spread to lymph nodes on the other side of the chest or in the neck is N2 or N3.
M (metastasis) 0–1 Shows if pleural mesothelioma has spread to other parts of the body. M0 means no spread to distant organs; M1 means it has spread to the bones, liver or other distant organs.

Tests before surgery

If radical surgery is being considered as a treatment option, you may have other scans and procedures to check whether mesothelioma has spread to other areas of the body.

FDG-PET – A positron emission tomography (PET) scan detects radiation from a low-level radioactive drug that is injected into the body. In an FDG-PET, the drug used is called fluorodeoxyglucose (FDG). The FDG shows up areas of abnormal tissue.

MRI scan – A magnetic resonance imaging (MRI) scan uses magnetic waves to create detailed cross-sectional pictures of the soft tissues in your body.

Mediastinoscopy – This procedure is used to sample the lymph nodes at the centre of the chest. A small cut is made in the lower neck, and an instrument is inserted to remove some lymph node tissue from the area between the lungs (mediastinum).

Endobronchial ultrasound (EBUS) – This procedure may be used along with, or instead of, mediastinoscopy. A tube called a bronchoscope, which has a small ultrasound probe on the end, will be put down your throat into your trachea. This allows the respiratory physician to target lymph nodes for biopsy.

Surgical staging – Before radical surgery for pleural mesothelioma, a less extensive operation may sample lymph nodes and other areas of the body. Surgical staging is not advised before a peritonectomy for peritoneal mesothelioma.


Prognosis

You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the illness.

Mesothelioma behaves differently in different people. It is often present for many months before being diagnosed at an advanced stage, which will affect prognosis. After diagnosis, mesothelioma may progress quickly or more slowly. If it progresses slowly, some people may live for several years.

Your doctor will consider several factors when discussing prognosis with you, including:

  • the appearance of the mesothelioma cells 
  • the stage 
  • the type of treatment you are able to have
  • your symptoms, such as weight loss or pain
  • your white blood cell count – people with normal levels usually have a better prognosis
  • your overall health – recovering quickly after procedures tends to suggest a better outcome.

While knowing the stage helps doctors plan treatment, it is not always useful for working out prognosis for people with mesothelioma. This is partly because it is hard to predict how quickly mesothelioma will grow. In general, the earlier cancer is diagnosed, the better. If the cancer has advanced to a point where it is difficult to treat successfully, the priority will be to relieve symptoms and improve your quality of life.


This information was last reviewed in May 2017
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