Mesothelioma

Mesothelioma Brigham System

Malignant mesothelioma can be categorized according to a number of different criteria. The first level of categorization generally has to do with where the cancer started (such as the lungs, heart, or abdomen). The next step for most doctors is to "stage" the cancer, or determine how far the disease has progressed. This staging step is often the most important piece of information when determining a prognosis and treatment plan. Doctors can gain important information by understanding how far the disease has progressed.

The field of cancer research and treatment has developed a variety of staging systems used to describe the progression and current state of a given disease. Most specific cancers have settled into using one particular method that is best suited for the tendencies and needs of that disease. In the world of mesothelioma, however, many subsets of the disease are very uncommon, making it difficult to heed the guidelines of just one system. The only form of mesothelioma that has been decisively staged is the most common form, or pleural mesothelioma. Doctors may apply staging principles to other forms of mesothelioma to facilitate conversation with the patient, but there are no hard and fast guidelines outside of the world of pleural mesothelioma.

Staging Mesothelioma

To stage a tumor, most doctors begin by using an imaging procedure to uncover how far the cancer has spread. This may include taking a chest x-ray or employing a more high-tech scanning process such as a CT, MRI or PET scan. Throughout this process, doctors are focusing on understanding the primary mass (or the extent of the main tumor), the extent to which the cancer has metastasized or spread, and whether or not lymph nodes have become involved. All major staging systems use a four-phased organization. In most cases, a diagnosis of Stage 3 or 4 is particularly serious. By this point, the patient may only be eligible for palliative treatments designed to relieve symptoms and improve quality of life.

Staging Mesothelioma with the Brigham System

The most recent staging system developed for use with malignant mesothelioma is the Brigham System. The Brigham System also uses four stages, and its variables include the extent to which lymph nodes are or are not involved and the likelihood that given tumor can be surgically removed. In the specific case of mesothelioma, then, the Brigham System has limited utility due to the fact that many mesothelioma cases are inoperable. Below is a basic guideline of the stages in the Brigham System:

  • Stage I: cancer is operable and can be removed, lymph nodes have not been affected
  • Stage II: cancerous cells in the pleura or lungs can be removed, cancer has spread to nearby lymph nodes
  • Stage III: cancer is inoperable and cannot be removed, cancerous cells have spread, lymph nodes are likely to be affected
  • Stage IV: cancer has greatly spread and is entirely inoperable, also known as distant metastatic cancer

Treating Mesothelioma

Many doctors base treatment decisions on the stage of the mesothelioma. The general treatment options for mesothelioma patients include surgery, radiation, and chemotherapy. If your cancer is in stage 3 or 4 under the Brigham System, however, it is by definition inoperable. While cancers diagnosed at stages 1 and 2 can often be treated to some measure by the physical removal of a tumor, later stages tend not to be removable. In some cases, doctors may surgically remove some large tumors in order to relieve pressure on internal organs and reduce discomfort. In very advanced cases of mesothelioma, however, the patient may not be strong enough to withstand surgery in any form. Your doctor will work with you to design the best treatment plan possible to combat mesothelioma.

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