Stages of Mesothelioma

Once malignant mesothelioma is found, staging will be done to find out if cancer cells have spread to other parts of the body. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. Peritoneal mesothelioma is not staged while there are three staging systems for pleural mesothelioma.

1. The most often used Butchart System is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.

Stage I - Mesothelioma is present in the right or left pleura and may also involve the lung, pericardium or diaphragm on the same side.

Stage II - Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.

Stage III - Mesothelioma has penetrated through the diaphragm into the peritoneum. Lymph nodes beyond those in the chest may also be involved.

Stage IV - There is evidence of metastasis or spread through the bloodstream to other organs.

2. The recent TNM system is similar to staging systems used for most other cancers.

Stage I - Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.

Stage II - Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.

Stage III - Mesothelioma has spread into the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor, with or without spread to subcarinal or mediastinal lymph nodes on the same side as the primary tumor. Subcarinal nodes are located at the point where the windpipe branches to the left and right lungs. Mediastinal lymph nodes are located in the space behind the chest bone in front of the heart.

Stage IV - Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or directly extends to the pleura or lung on the opposite side, or into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

3. The latest Brigham System stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement

Stage I - Resectable mesothelioma and no lymph node involvement

Stage II - Resectable mesothelioma but with lymph node involvement

Stage III - Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement

Stage IV - Distant metastatic disease.

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Treatments of Mesothelioma Cancer

Treatment options for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy and chemotherapy. Sometimes combination of these treatments are used.

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Mesothelioma is a life-threatening disease and cannot be left untreated. The sooner it is diagnosed the better a patient's chances are of fighting this deadly cancer.

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Types of Lung Cancer

Lung cancer or bronchogenic arcinoma, a life threatening disease, is the uncontrolled growth of abnormal cells in one or both of the lungs. While normal lung tissue cells reproduce and develop into healthy lung tissue, these abnormal cells reproduce rapidly and never grow into normal lung tissue. As a result, lump mass known as a tumor are formed, disrupting the lungs and making it difficult to function properly. Tumors can be benign (non-cancerous) or malignant (cancerous). Benign tumors may grow causing discomfort and bleeding, but they do not spread to other parts of the body and can be removed.

Malignant tumors grow aggressively, spread into other areas of the body and destroy normal tissue. The process of spreading the tumor is called metastasis (secondary tumors) and the areas of tumor growth at these distant sites are called metastases.

Usually lung cancer, develops within the wall or epithelium of the bronchial tree. But it can start anywhere in the lungs and affect any part of the respiratory system. Lung cancer mostly affect people between the ages of 55 and 65 and often takes many years to develop. Once it occurs, cancer cells can break away and may spread to the lymph nodes or other tissues in the chest, including the lung opposite to where it originated. It may also spread to other organs of the body, such as the bones, brain or liver.

Types of Lung Cancer

There are two major types of lung cancer. They are Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) or oat cell cancer. The classification of the lung cancer is based upon the microscopic appearance (i.e. cell size) of the tumor cells. Each type of lung cancer grows and spreads in different ways, and is treated differently. If the cancer has features of both types, it is called mixed small cell/large cell cancer.

Non-small cell lung cancer is more common than SCLC and it generally grows and spreads more slowly. There are three main types of NSCLC. They are :
1. Squamous cell carcinoma or epidermoid carcinoma usually starts in the large bronchi and very often stays in the central chest area, without spreading, for longer periods of time than other lung cancers.
2. Adenocarcinoma are found along the outer or peripheral areas of the lungs and under the lining of the bronchi. Bronchioloalveolar carcinoma, a sub type of adenocarcinoma develops around scars on the outer edges of the lungs.
3. Large cell carcinoma, can be found in any part of the lung and tends to grow and spread quickly. It is also known as undifferentiated carcinomas.

SCLC are almost related with smoking and grows more quickly and form large tumors that can spread widely through the body. They often starts in the bronchi near the center of the chest.

Other tumors found in the lungs are :

Carcinoid tumor which arise from glands near the bronchi. This slow-growing tumor is usually cured by surgery.

Lymphoma or metastatic

Mesothelioma, a less common type is found in people who have been exposed to asbestos. It is a cancer of the membrane which covers the surface of the lungs and lines the inside of the chest. Exposure to asbestos particles in the air increases the risk of developing malignant mesothelioma.

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Causes of Lung Cancer

Cigarette smoking is the main cause for developing lung cancer. Air pollution and industrial exposures also may cause problem to the lungs. Persons exposed to harmful substances, such as arsenic, asbestos, radioactive dust, and radon have a greater chance of developing lung cancer if they smoke. Not all smokers develop lung cancer and not all people with lung cancer are smokers.

The most significant cause of lung cancer is exposure to carcinogenic (cancer-causing) agents. Harmful substances, called carcinogens, in tobacco damage the lung cells. Squamous cell carcinoma and small cell carcinoma are the most common types found in smokers. Lung cancer in smokers is related with the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales. Smoking at a younger age raises the risk and the death rate from lung cancer. Stopping smoking greatly reduces a person's risk for developing lung cancer.

Cigar and pipe smoking increases the risk of lung cancer but not as much as smoking cigarettes does. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke or secondhand smoke- the smoke that non-smokers are exposed to when they share air space with someone who is smoking.

Radon, the radioactive gas found in substantial concentration in soil, rocks and some building materials, is considered to be the second leading cause of lung cancer. This is a detectable and preventable problem. Smokers are sensitive to the effects of radon. High radon levels in some mines can increase the lung cancer risk for miners.

Asbestos is another risk factor for lung cancer. If inhaled, asbestos particles can lodge in the lungs, damaging cells and increasing the risk for lung cancer. People who work with asbestos have a higher risk of getting Mesothelioma, cancer of the lining of the lung. If they smoke as well, the risk is greatly increased.

Certain lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD), increase a person's chance of developing lung cancer. Air pollution from motor vehicles, factories, and other sources may increase the risk for lung cancer, but it has not been established accurately. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Contact with certain chemicals and substances, such as uranium, chromium and nickel, can cause lung cancer, but these are very rare causes. Certain reports indicate that diet low in fruits and vegetables may increase the chances of getting cancer, if you are exposed to tobacco smoke.

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Symptoms of Lung Cancer

Symptoms

Lung cancer in its early stage and sometimes even later may not cause any signs and symptoms. In its advanced stage, the cancer cells interfere with normal lung function. The symptoms associated with lung cancer can result from the original tumor or from tumors that have spread to other organs. The cancers are usually identified incidentally when a chest x-ray is performed for another reason.

Common signs and symptoms of lung cancer are :

A cough that does not go away and gets worse over time

Coughing up blood (hemoptysis) or bloody mucus.

Chest, shoulder, or back pain that doesn't go away and often is made worse by deep

hoarseness

Weight loss and loss of appetite

Increase in volume of sputum

Wheezing

Shortness of breath

Repeated respiratory infections, such as bronchitis or pneumonia

repeated problems with pneumonia or bronchitis

fatigue and weakness

new onset of wheezing

swelling of the neck and face

Clubbing of the fingers and toes. The nails appear to bulge out more than normal.

Some patients may have paraneoplastic syndromes which are caused by biologically active substances that are secreted by the tumor.

If any symptoms is found, it is better to consult a doctor because only doctor can make a diagnosis.

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Diagnosis of Lung Cancer

To find out if lung cancer may be present, the doctor evaluates a person's medical history, smoking history, their exposure to environmental and occupational substances, and family history of cancer. The doctor will also give the patient a physical examination. This is for detecting any signs of cancer such as swollen lymph nodes in the neck or collarbone area. If lung cancer is suspected, a patient must undergo a series of diagnostic tests.

In some people lung cancer doesn't show any symptoms. In such people a method called screening is used to detect the cancer. The two main test used for this are chest x-rays and sputum cytology

Chest x-ray : This is the first test to verify any spot on the lungs. X-rays are plain pictures of the lung, which will help to identify any abnormal growths. If lung cancer is suspected, a simple test called sputum cytology is performed. It is the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs. The presence abnormal or cancerous (malignant) cells can be discovered by this test.

Not all abnormalities are cancers. Some people develop scarring and calcium deposition in their lungs that may look like tumors on a chest x-ray film. In such cases, to confirm the diagnosis various scanning are prescribed by the specialist.

CT (Computed tomography) or CAT scan : It is a special kind of x-ray which reveal much more than chest x-ray. A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. It gives a detailed information about the size, shape, and place of a tumor. CT scan helps to determine whether the cancer is in the chest wall and rib area. It also helps to find the enlarged lymph nodes that might contain cancer and the tumors in other organs that might be affected by the spreading of lung cancer.

MRI (Magnetic Resonance Imaging) scan :MRI use radio waves and strong magnets to create an image. This scanning is useful in finding lung cancer, that has spread the brain or spinal cord.

PET (Positron Emission Tomography) scan : PET uses a low-dose radioactive sugar to trace the activity of body cells on sugar. A very small amount of radioactive substance is injected into a vein (usually on hand) and a scan is then taken. Areas of cancer are usually more active than surrounding tissue so they take up more of the radioactive substance and show up on the scan. PET helps to determine whether lung cancer has spread to lymph nodes. It is also helpful in telling whether a spot on your chest x-ray is cancer.

Bone Scans : A bone scan can determine whether the cancer has spread to the bones. It is usually done in patients with small cell lung cancer. A small amount of radioactive substance is injected into a vein and this substance builds up in areas of bone that may be abnormal because of cancer. In patients with non-small cell lung cancer, bone scan is done when other tests or symptoms suggest that the cancer has spread to the bones.

To confirm the presence of lung cancer, the doctor must examine tissue from the lung. This is called biopsy which is the removal of a lung tissue sample for examination under a microscope. Biopsies are obtained in different ways depending on the location of the tumor: They are :

Bronchoscopy : Bronchoscope is a thin, lighted, flexible tube with a tiny camera on the end. This is passed through the mouth or nose and down through the windpipe. From there, the tube can be inserted into the airways (bronchi) of the lungs. Small samples of tissue are collected through this tube. Bronchoscopy, which is used to determine the extent of the tumor, has some risks and requires a specialist proficient in performing the procedure.

Needle biopsy : If a tumor is on the periphery of the lung, it usually cannot be seen with bronchoscopy. After the chest surface is cleaned and prepared, the skin and the chest wall are numbed. A long, thin needle is inserted through the chest wall in the lung to remove a lung tissue sample. A chest x-ray or CT scanning is used to guide the needle.

Thoracentesis : Lung cancers, both primary and metastatic, can cause fluid to collect in the sac surrounding the lung. This is called pleural effusion. Thoracentesis, which is important for both staging and diagnosis, is similar to needle biopsy. The skin is numbed and a needle is placed between the ribs to remove a fluid sample.

Thoracoscopy : It uses a thin, lighted tube connected to a video camera and monitor to view the space between the lungs and the chest wall. It is used to check whether the fluid around the lungs is caused by cancer.

Thoracotomy : Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures. In such cases the only way to obtain a biopsy is by performing a surgery. The chest is opened and as much of the tumor as possible is removed surgically. A biopsy is taken from the removed tumor. This procedure is a major operation performed in a hospital.

Mediastinoscopy : It is performed to determine the extent that the cancer has spread into the area of the chest between the lungs. A small cut is made into the lower part of the neck, above the breastbone. A mediastinoscope is inserted and sample tissues are taken from the enlarged lymph nodes along the windpipe. Mediastinoscopy is a very important step to determine whether the tumor can be surgically removed or not.

Bone marrow biopsy : After the area is numbed, a needle is used to remove a small piece of bone, usually from the back of the hip bone. This is done mostly to help find if small cell lung cancer has spread to the bones.

Blood tests : Blood tests are performed to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment. A complete blood count (CBC) shows whether your blood has the correct number of different cell types. This test will be done often if you are treated with chemotherapy because these drugs can affect the blood-forming cells of the bone marrow.

Once a tumor is found, it must be determined if and how widely the cancer has spread. It is known as staging.

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Stages of Lung Cancer

Stages of Lung Cancer

Staging is very important and should be performed before treatment started. It is based on size of the tumor, location of the tumor, and degree of metastasis of the tumor. Staging is beneficial to plan a treatment program, to determine eligibility for surgery, to assess response by stage for results reporting and to estimate prognosis. The higher the tumor stage, the less likely the disease will be cured. Staging of tumor is according to the TNM classifications. T refers to the size and extent of the primary tumor, N refers to involvement of regional nodes and M refers to the presence or absence of metastatic disease.

There are different staging systems for small cell lung cancer and non-small cell lung cancer. Limited and extensive are the two stage system in SCLC. In limited stage, cancer is found only in one lung and in lymph nodes on the same side of the chest or in fluid around the lung. If the cancer has spread beyond one lung, to lymph nodes on the other side of the chest or to other organs, it is called extensive.

There are 4 stages for NSCLC. They are :

Stage 1 - It is very localised and tumor of any size is found only in the lung.

Stage 2 - Tumor has spread to lymph nodes associated with the affected lung

Stage 3 - Tumor has spread into the tissue around the lung near to where the cancer started. This can be into the chest wall, the covering of the lung (pleura), the middle of the chest (mediastinum) or other lymph nodes.

Stage 4 - Tumor has spread to another part of the body

There are many options for the treatment of lung cancer at each stage.

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