Recovering The SelfA Journal of Hope and Healing


Pleural Mesothelioma: Understanding the 3 Types of Staging Systems

by Katie Johnson Mesothelioma

Seventy-five percent of diagnosed mesothelioma cases are ‘pleural.’ This form takes root in body tissue around the lungs. What’s dismissed as harmless periods of coughing and shortness of breath could result in a terminal disease.

Those diagnosed with mesothelioma have a life expectancy of less than 18 months.  The disease may take 15 to 60 years to take effect. Affecting many elderly (especially those working industrial or military jobs in the 1930s-70s),pleural mesothelioma necessitates better understanding.


mesothelioma prognosis depends on the development of the cancer, existing tumors, as well as the potential spreading within the body. Knowing the present stage of the cancer helps target the best outcomes and treatments.

Methods and stages vary amongst professionals and second opinions are common. Using one of three systems, doctors assign ‘stages’ reflecting observed growth and impact on the body. Stages depend on several factors, such as existing tumors and the cancer’s spread to multiple organs and lymph nodes.

The Brigham, TNM, and Butchart are staging systems, although some believe none are altogether accurate.

Brigham System

In the first stage, tumors are confined to the lining of the lungs, having not spread to the lymph nodes.  In the second stage, while cancer still confined to the lungs, lymph nodes are identified as cancerous.

At stage three, tumors spread and could infect the chest wall, diaphragm, or more lymph nodes. At the last stage, the cancer has spread to other regions of the body and organs, deemed irreversible.


The TNM system is three-pronged, concerned with tumors, lymph nodes, and the cancer’s mobility within the body. Also referred as the IMIG staging system, it’s the most widely adopted to treat those with pleural cancer. (The Brigham and Butchart were designed to treat those who underwent extrapleural pneumonectomy.)

After evaluation, doctors assign a value to the three respective areas and then assign a stage to the cancer. The ‘T’ (for tumor) ranges from an ‘X,’ indicating none present, to a T4, meaning the cancer has spread throughout the lungs and chest cavity, with bigger or multiple tumors observed.

The ‘N’ number (for lymph nodes), describes if the cancer has spread to one or more glands of the immune system. Ranging from ‘NX’ to ‘N3,’ doctors observe whether zero to multiple lymph nodes (and the entire immune system) are infected.

The ‘M’ is concerned with the cancer’s metastasis, or present mobility. Spreading cancer inspires added tumors and infects more organs of the body, becoming increasingly irreversible. In stage ‘MX,’ no mobility is measured, while ‘M1’ designates other parts of the body are infected.


In the first stage of this rating system, doctors observe the cancer confined to half of the chest and surgery is usually suggested. In the second stage, the cancer has spread to the chest wall with the esophagus, heart, or lymph nodes also infected. Doctors suggest high doses of radiation for these patients.

In stage three, the cancer has spread to the diaphragm with the mesothelioma cells traveling to lymph nodes outside of the chest. Tumors of such progression are usually unresponsive to curative therapies, with doctors suggestingpalliative options and chemotherapy drugs given directly to the chest region. At stage four, the cancer has made its way into a patient’s bloodstream and tumors are present in the liver, brain, bones, and other organs, with doctors deeming the mesothelioma terminal.

About the Author

Katie Johnson has a diverse background in PR, journalism and digital marketing. She is focused on creating a unique community for family, friends or those who are diagnosed with mesothelioma or an asbestos-related disease.


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