After your initial diagnosis has been confirmed – I.e. from the results of your x-rays, you will be referred to either a medical oncologist, surgeon, or radiation oncologist. He or she will be an expert in treating mesothelioma and may have experience in performing clinical trials and laboratory research.

The specialist who is treating you will need to learn the extent of your disease through a process of ‘staging’. Staging is a process that evaluates the extent of the disease and your specialist will determine treatment options depending on the stage of your mesothelioma. Medical specialists currently use one of three staging systems. Each system measures the different variables.

• TNM
•  Butchart
•  Brigham

The TNM System

The TNM system  – (International Mesothelioma Interest Group staging system) involves evaluation of the tumour itself and consists of the following stages:

1. (T) Stage I – The mesothelioma is localised in the membrane lining of either the left or right chest pleura and   has not spread to lymph nodes.

2. (N) Stage II – The mesothelioma has advanced, spreading from the lining of the chest cavity into the outer lining of the lung and into the diaphragm, or the lung.

3. (M) Stage II – The mesothelioma has spread into the first layer of the chest wall, or the chest cavity behind the breastbone (mediastinum). It may have also advanced to hearts outer layer or to lymph nodes on either side of the chest.

The Butchart System

The Butchart system – is the oldest and most used staging system and divides mesothelioma into four stages.

1. Stage I – The mesothelioma is in the lining of either the left or right lung and may involve the diaphragm on the same side.

2. Stage II – The mesothelioma has invaded the chest wall, oesophagus, heart, or lung lining on both sides and lymph nodes.

3. Stage III – The mesothelioma has penetrated the diaphragm and through the lining of the peritoneum or abdominal cavity.

4. Stage IV – The mesothelioma has advanced to other organs (metastasis).

The Brigham System

The Brigham System – is the most modern staging system but is least used as it is primarily concerned with the option of surgery but mesothelioma is rarely operable.

1. Stage I – The mesothelioma tumour is able to be removed surgically as it has not spread to lymph nodes

2. Stage II - The mesothelioma has spread to the lymph nodes.

3. Stage III – The mesothelioma has penetrated through the chest wall, involving heart, diaphragm, abdominal cavity. Lymph nodes may not be involved.

4. Stage IV – The mesothelioma has advanced to other organs (metastasis).

Your specialist will use the following ‘imaging procedures’ in order to determine which path of ‘staging’ to take in the treatment of your mesothelioma. CT, MRI, and PET scans.

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