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Mesothelioma Staging Systems - Stage 4

Generally, Stage 4 mesothelioma is considered advanced and has metastasized to locations that are distant from the primary tumor site. Malignant mesothelioma typically metastasizes to locations such as the brain, throughout the abdomen, and in organs of the abdominal and chest cavity. For this reason, it is sometimes referred to as "distant metastatic cancer."

Stage 4 and the Butchart System

The Butchart System, the oldest of all cancer staging systems, categorizes an individual case of mesothelioma based mainly on the size and spread of the primary tumor. This system has four stages. In Stage 4 of the Butchart system, mesothelioma has metastasized, spreading through the bloodstream to organs and tissues that are distant from the primary tumor site.

Stage 4 and the TNM System

The TNM system is newer than the Butchart system, and categorizes cancer based on three factors: the size of the tumor, whether the cancer has spread from its point of origin to nearby lymph nodes, and whether the cancer has metastasized. This system may be used to stage pleural and peritoneal mesothelioma. The TNM system uses four stages like the other systems, but is slightly more complex than other systems since subcategories define the size of tumors and other factors.

In Stage 4 of the TNM system, mesothelioma has metastasized to one or both sides of the body. For example, in pleural mesothelioma both lungs might be affected, whereas in peritoneal mesothelioma both sides of the abdomen might be affected. In addition, mesothelioma may have spread to organs in the neck and lymph nodes are probably involved.

The Brigham System

The Brigham system is the newest of the three systems used to stage mesothelioma. This system categorizes mesothelioma according to whether or not tumors can be removed via surgery, and whether the cancer has spread to nearby lymph nodes. The Brigham system includes four stages.

In Stage 4 of the Brigham system, mesothelioma is inoperable due to the size of tumors and the penetration of asbestos cancer into vital organs. In addition, mesothelioma has metastasized to other locations, meaning cancer is more than likely to recur even if primary tumors are removed.

Treatment Options for Stage 4 Mesothelioma

Patients with stage 4 have few treatment options. With Stage 4 mesothelioma, the prognosis is generally very poor due to the spread of cancer to multiple locations. Additionally, primary tumors have often penetrated too deeply into organs and tissues to be removed. Finally, the general health of stage 4 patients is typically too poor to withstand the physical strain of surgery.

Stage 4 treatments are therefore limited to non-surgical palliative treatments that are performed to relieve symptoms of the disease. These may include procedures such as thoracentesis or paracentesis, where built-up fluid is removed from the lungs or abdomen to relieve pain and pressure on internal organs. Chemotherapy and radiation therapy may also be used to shrink tumors to provide relief from symptoms. Because these treatments often carry serious side effects, patients should carefully consider whether or not they wish to endure such treatments at this final stage.

Sources:

1. Dodson, R. and Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. Taylor & Francis: Boca Raton. 2006.
2. Galateau-Salle, Francoise. Pathology of Malignant Mesothelioma. Springer-Verlag London Limited: London. 2006.
3. http://www.cancer.gov/cancertopics/factsheet/Detection/staging
4. http://cancerguide.org/basic.html
5. http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/Patient/

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