Mesothelioma Butchart System

Once a patient is diagnosed with mesothelioma, a doctor will "stage" the cancer, or determine how far the disease has progressed. This staging step is critical and very important when determining a patient's prognosis and treatment plan.

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 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. 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 Butchart System

The oldest and most established staging system for pleural mesothelioma is the Butchart System. This is the system that is most commonly used by doctors in the field of mesothelioma, but it is generally not used for any cases that are not pleural in nature. The Butchart System uses the size of the primary tumor to divide cancers into four distinct stages. Unlike other systems, the Butchart System pays little attention to the affect of secondary tumors and complications that have been caused by the mesothelioma. The focus is almost entirely on the primary tumor itself.

The Butchart System, which was developed by Dr. Eric Butchart, a mesothelioma expert, provides less information and detail than many other options but it can be used more quickly to provide a baseline read on a patient's situation.

  • Stage I: At Stage I, the mesothelioma tumor is relegated to a relatively small mass that appears only on one side of the lung cavity or the other. Generally, this means that only a portion of the pleural membrane is affected. Under the Butchart System, Stage I mesothelioma may also have invaded the diaphragm on the same side as the primary tumor.
  • Stage II: According to the Butchart System, Stage II mesothelioma is defined as pleural mesothelioma in which the primary tumor has spread from its point of origin (the pleural membrane of one lung) to the pleural membrane of the other lung. In some cases, the Stage II diagnosis may be applied to a cancer that has spread from one pleural membrane to the pericardial membrane of the heart, the esophagus, or, in some cases, the lymph nodes.
  • Stage III: Under the Butchart System, a designation of Stage III means that the cancer has spread from its point of origin (the pleural lining) to the abdominal cavity. Other locations within the body may also be affected, and it is likely that lymph nodes across the system have been affected by cancerous cells.
  • Stage IV: Under the Butchart System, Stage IV is used to refer to a case in which the mesothelioma has metastasized widely. Cancerous cells have likely spread via the blood stream and can be found in a variety of organs and tissues that are far away from the tumor's original location.


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